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Official Description

Parenteral infusion pump, stationary, single or multi-channel
Short Descr Parenteral infusion pump sta
Coverage Special coverage instructions apply
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
CIM 65-10
MCM 2130
BETOS D1E – Other DME
TOS Code(s) R – Rental of DME
Added Date 1/1/1989
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
IOM 100-02, 15, 120
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
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
KI Dmepos item, second or third month rental
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
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
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
RI Ramus intermedius coronary artery
Date
Action
Notes
1989-01-01 Added Code added 1/1/1989
Code
Description
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