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Official Description

Gravity assisted traction device, any type
Short Descr Gravity assisted traction de
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 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 1
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
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
AT Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942)
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
KH Dmepos item, initial claim, purchase or first month rental
NU New equipment
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
1986-01-01 Added Code added 1/1/1986
Code
Description
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