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Official Description

Oximeter device for measuring blood oxygen levels non-invasively
Short Descr Oximeter non-invasive
Coverage Carrier Priced
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
BETOS Z2 – Undefined codes
TOS Code(s) 9 – Other medical items or services
Added Date 1/1/2003
APC Status Indicator Items and Services Packaged into APC Rates
MUE 0
MUE 0
IOM 100-03, 4, 280.1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
EP Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program
KX Requirements specified in the medical policy have been met
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
U4 Medicaid level of care 4, as defined by each state
GZ Item or service expected to be denied as not reasonable and necessary
U1 Medicaid level of care 1, as defined by each state
CR Catastrophe/disaster related
GA Waiver of liability statement issued as required by payer policy, individual case
GX Notice of liability issued, voluntary under payer policy
KR Rental item, billing for partial month
N1 Group 1 oxygen coverage criteria met
NU New equipment
RA Replacement of a dme, orthotic or prosthetic item
Date
Action
Notes
2003-01-01 Added Code added 1/1/2003
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