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Official Description

Wheelchair, pediatric size, rigid, adjustable, without seating system
Short Descr Rgd ped wc adjstabl w/o seat
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 D1D – Wheelchairs
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2003
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
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
RR Rental (use the 'rr' modifier when dme is to be rented)
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KX Requirements specified in the medical policy have been met
NU New equipment
Date
Action
Notes
2009-01-01 Changed Code description changed
2003-01-01 Added Code added 1/1/2003
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