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Official Description

Segmental pneumatic appliance for use with pneumatic compressor, trunk
Short Descr Segmental pneumatic trunk
Coverage Special coverage instructions apply
Pricing Indicator(s) 36 – Supplies And Surgical Dressings - Capped rental DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
Processing Note NCD MANUAL 280.1.
BETOS D1E – Other DME
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2009
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KI Dmepos item, second or third month rental
KH Dmepos item, initial claim, purchase or first month rental
GZ Item or service expected to be denied as not reasonable and necessary
NU New equipment
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GA Waiver of liability statement issued as required by payer policy, individual case
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
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
RA Replacement of a dme, orthotic or prosthetic item
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
2009-01-01 Added -
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