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Official Description

Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device
Short Descr Nontherm electromgntc device
Coverage Special coverage instructions apply
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')
CIM 35-102
BETOS D1E – Other DME
TOS Code(s) 9 – Other medical items or services
Added Date 1/1/2003
APC Status Indicator Non-Covered Service, not paid under OPPS
MUE 0
MUE 0
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
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GX Notice of liability issued, voluntary under payer policy
KX Requirements specified in the medical policy have been met
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
2003-01-01 Added Code added 1/1/2003
Code
Description
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