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Official Description

Iv pole
Short Descr Iv pole
Coverage Carrier Priced
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
BETOS D1E – Other DME
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/1985
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)
BA Item furnished in conjunction with parenteral enteral nutrition (pen) services
NU New equipment
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
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
BU The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision
BR The beneficiary has been informed of the purchase and rental options and has elected to rent the item
CR Catastrophe/disaster related
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
JB Administered subcutaneously
KA Add on option/accessory for wheelchair
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KG Dmepos item subject to dmepos competitive bidding program number 1
KH Dmepos item, initial claim, purchase or first month rental
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KU Dmepos item subject to dmepos competitive bidding program number 3
RA Replacement of a dme, orthotic or prosthetic item
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
UB Medicaid level of care 11, as defined by each state
UE Used durable medical equipment
Date
Action
Notes
1985-01-01 Added Code added 1/1/1985
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