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Try CasePilot| Short Descr | Port o2 cont, liq over 4 lpm | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 33 – Supplies And Surgical Dressings - Oxygen and oxygen equipment (price subject to floors and ceilings) | MPI | A – Not applicable, as HCPCS priced under one methodology | CIM | 60.4 | MCM | 4107.9 | BETOS | D1C – Oxygen and supplies | TOS Code(s) | P – Lump sum purchase of DME, prosthetics, orthotics | Added Date | 1/1/2019 | APC Status Indicator | Non-Implantable Durable Medical Equipment | MUE | 0 | MUE | 1 | OTS Orthotic | No |
| KX | Requirements specified in the medical policy have been met |
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| 2019-01-01 | Added | Added |
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