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Official Description

Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)
Short Descr Implantable pump replacement
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 60-14
BETOS D1E – Other DME
TOS Code(s) 9 – Other medical items or services
Added Date 1/1/2001
APC Status Indicator Items and Services Packaged into APC Rates
MUE 1
MUE 1
IOM 100-03, 1, 50.3
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
NU New equipment
Date
Action
Notes
2001-01-01 Added Code added 1/1/2001
Code
Description
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