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Official Description

Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation
Short Descr Tens four lead
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 35-20
MCM 4107.6
BETOS D1E – Other DME
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/1986
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
IOM 100-03, 2, 160.2
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
KX Requirements specified in the medical policy have been met
NU New equipment
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
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
EY No physician or other licensed health care provider order for this item or service
GZ Item or service expected to be denied as not reasonable and necessary
KH Dmepos item, initial claim, purchase or first month rental
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KV Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
Date
Action
Notes
1986-01-01 Added Code added 1/1/1986
Code
Description
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