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Try CasePilot| Short Descr | Portable oxygen concentrator | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 33 – Supplies And Surgical Dressings - Oxygen and oxygen equipment (price subject to floors and ceilings) | MPI | A – Not applicable, as HCPCS priced under one methodology | CIM | 60-4 | BETOS | D1C – Oxygen and supplies | TOS Code(s) | R – Rental of DME | Added Date | 1/1/2006 | APC Status Indicator | Non-Implantable Durable Medical Equipment | MUE | 0 | MUE | 1 | IOM | 100-03, 4, 240.2 | 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 | N1 | Group 1 oxygen coverage criteria met | CR | Catastrophe/disaster related | N2 | Group 2 oxygen coverage criteria met | RA | Replacement of a dme, orthotic or prosthetic item | KT | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item | N3 | Group 3 oxygen coverage criteria met | QH | Oxygen conserving device is being used with an oxygen delivery system | QF | Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | GA | Waiver of liability statement issued as required by payer policy, individual case | NU | New equipment | 33 | Preventive services: when the primary purpose of the service is the delivery of an evidence based service in accordance with a us preventive services task force a or b rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. for separately reported services specifically identified as preventive, the modifier should not be used. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | E1 | Upper left, eyelid | EA | Erythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer chemotherapy | EY | No physician or other licensed health care provider order for this item or service | GL | Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) | 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 | K1 | Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator. | KJ | Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen | KK | Dmepos item subject to dmepos competitive bidding program number 2 | MS | Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty | NR | New when rented (use the 'nr' modifier when dme which was new at the time of rental is subsequently purchased) | QB | Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed | QE | Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (lpm) | QG | Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (lpm) |
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| 2006-01-01 | Added | Code added 1/1/2006 |
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