HCPCS Code E1399

Official Description

Durable medical equipment, miscellaneous

Short Descr	Durable medical equipment mi
Coverage	Carrier Priced
Pricing Indicator(s)	46 – Supplies And Surgical Dressings - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)
MPI	A – Not applicable, as HCPCS priced under one methodology
BETOS	D1E – Other DME
TOS Code(s)	A – Used durable medical equipment (DME)
Added Date	1/1/1986
APC Status Indicator	Non-Implantable Durable Medical Equipment
MUE	1
MUE	Not applicable/unspecified.
OTS Orthotic	No
CCS Clinical Classification	243 - DME and supplies

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
NU	New equipment
U1	Medicaid level of care 1, as defined by each state
RR	Rental (use the 'rr' modifier when dme is to be rented)
KX	Requirements specified in the medical policy have been met
RB	Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
N1	Group 1 oxygen coverage criteria met
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)
BP	The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
GX	Notice of liability issued, voluntary under payer policy
GZ	Item or service expected to be denied as not reasonable and necessary
RT	Right side (used to identify procedures performed on the right side of the body)
AB	Audiology service furnished personally by an audiologist without a physician/npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary
CR	Catastrophe/disaster related
LT	Left side (used to identify procedures performed on the left side of the body)
A2	Dressing for two wounds
BO	Orally administered nutrition, not by feeding tube
GL	Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
GW	Service not related to the hospice patient's terminal condition
SC	Medically necessary service or supply
UB	Medicaid level of care 11, as defined by each state
51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
A1	Dressing for one wound
A5	Dressing for five wounds
CG	Policy criteria applied
CT	Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard
F9	Right hand, fifth digit
GO	Services delivered under an outpatient occupational therapy plan of care
GP	Services delivered under an outpatient physical therapy plan of care
GS	Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
KE	Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KF	Item designated by fda as class iii device
KI	Dmepos item, second or third month rental
KJ	Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KT	Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KU	Dmepos item subject to dmepos competitive bidding program number 3
KY	Dmepos item subject to dmepos competitive bidding program number 5
MS	Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
N2	Group 2 oxygen coverage criteria met
N3	Group 3 oxygen coverage criteria met
QH	Oxygen conserving device is being used with an oxygen delivery system
RA	Replacement of a dme, orthotic or prosthetic item
U3	Medicaid level of care 3, as defined by each state
U6	Medicaid level of care 6, as defined by each state
U8	Medicaid level of care 8, as defined by each state
UE	Used durable medical equipment