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Official Description

Segmental pneumatic appliance for use with pneumatic compressor, half leg
Short Descr Seg pneumatic appli half leg
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 1/1/1994
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 2
IOM 100-03, 4, 280.6
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
NU New equipment
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
GA Waiver of liability statement issued as required by payer policy, individual case
KX Requirements specified in the medical policy have been met
RA Replacement of a dme, orthotic or prosthetic item
Date
Action
Notes
1994-01-01 Added Code added 1/1/1994
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Description
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