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Official Description

Manual wheelchair accessory, anti-tipping device, each
Short Descr Wheelchair anti-tipping devi
Coverage Carrier Priced
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
CIM 60-9
Cross-Reference(s) K0021
BETOS D1D – Wheelchairs
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/1986
APC Status Indicator Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
MUE 0
MUE 2
IOM 100-03, 4, 280.1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
NU New equipment
RR Rental (use the 'rr' modifier when dme is to be rented)
RT Right side (used to identify procedures performed on the right side of the body)
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)
KU Dmepos item subject to dmepos competitive bidding program number 3
KY Dmepos item subject to dmepos competitive bidding program number 5
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
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
UE Used durable medical equipment
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)
CR Catastrophe/disaster related
EY No physician or other licensed health care provider order for this item or service
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
KA Add on option/accessory for wheelchair
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KM Replacement of facial prosthesis including new impression/moulage
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
N1 Group 1 oxygen coverage criteria met
TW Back-up equipment
Date
Action
Notes
1986-01-01 Added Code added 1/1/1986
Code
Description
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