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Official Description

Continuous passive motion exercise device for use on knee only
Short Descr Cont pas motion exercise dev
Coverage Special coverage instructions apply
Pricing Indicator(s) 31 – Supplies And Surgical Dressings - Frequently serviced DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
CIM 60-9
BETOS D1E – Other DME
TOS Code(s) R – Rental of DME
Added Date 1/1/1986
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 21
IOM 100-03, 4, 280.1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
GA Waiver of liability statement issued as required by payer policy, individual case
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GZ Item or service expected to be denied as not reasonable and necessary
KR Rental item, billing for partial month
NU New equipment
EY No physician or other licensed health care provider order for this item or service
CR Catastrophe/disaster related
KS Glucose monitor supply for diabetic beneficiary not treated with insulin
Date
Action
Notes
1986-01-01 Added Code added 1/1/1986
Code
Description
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