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Official Description

Tablo hemodialysis system for the billable dialysis service
Short Descr Tablo for dialysis service
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')
BETOS P9B – Dialysis services (non-medicare fee schedule)
TOS Code(s) L – ESRD supplies
Added Date 1/1/2022
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
AX Item furnished in conjunction with dialysis services
Date
Action
Notes
2022-01-01 Added Code added.
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