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Official Description

Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification
Short Descr Whlchr special size/constrc
Coverage Special coverage instructions apply
Pricing Indicator(s) 45 – Supplies And Surgical Dressings - Customized DME items
MPI A – Not applicable, as HCPCS priced under one methodology
CIM 60-6
BETOS D1D – Wheelchairs
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/1986
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
IOM 100-03, 4, 280.3
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
Date
Action
Notes
1986-01-01 Added Code added 1/1/1986
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