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Official Description

Intermittent limb compression device (includes all accessories), not otherwise specified
Short Descr Inter limb compress dev nos
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) A – Used durable medical equipment (DME)
Added Date 1/1/2007
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 1
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
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
NU New equipment
RR Rental (use the 'rr' modifier when dme is to be rented)
KX Requirements specified in the medical policy have been met
KH Dmepos item, initial claim, purchase or first month rental
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
GZ Item or service expected to be denied as not reasonable and necessary
GT Via interactive audio and video telecommunication systems
GX Notice of liability issued, voluntary under payer policy
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)
Date
Action
Notes
2023-10-01 Note Miscellaneous change (BETOS or Type of Service)
2007-01-01 Added Code added 1/1/2007
Code
Description
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