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Official Description

Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater
Short Descr Amb infusion pump mechanical
Coverage Carrier Priced
Pricing Indicator(s) 36 – Supplies And Surgical Dressings - Capped rental 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 1/1/2000
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)
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KI Dmepos item, second or third month rental
KH Dmepos item, initial claim, purchase or first month rental
KX Requirements specified in the medical policy have been met
JB Administered subcutaneously
GA Waiver of liability statement issued as required by payer policy, individual case
HK Specialized mental health programs for high-risk populations
JA Administered intravenously
JK One month supply or less of drug or biological
KK Dmepos item subject to dmepos competitive bidding program number 2
NU New equipment
Date
Action
Notes
2000-01-01 Added Code added 1/1/2000
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