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Official Description

Pneumatic compressor, segmental home model with calibrated gradient pressure
Short Descr Pneum compres w/cal pressure
Coverage Special coverage instructions apply
Pricing Indicator(s) 32 – Supplies And Surgical Dressings - Inexpensive & routinely purchased DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
CIM 60-16
BETOS D1E – Other DME
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/1988
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
IOM 100-03, 4, 280.6
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
NU New equipment
GA Waiver of liability statement issued as required by payer policy, individual case
RR Rental (use the 'rr' modifier when dme is to be rented)
KX Requirements specified in the medical policy have been met
CR Catastrophe/disaster related
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
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
GZ Item or service expected to be denied as not reasonable and necessary
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
LT Left side (used to identify procedures performed on the left side of the body)
RA Replacement of a dme, orthotic or prosthetic item
UE Used durable medical equipment
Date
Action
Notes
1988-01-01 Added Code added 1/1/1988
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