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Official Description

Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
Short Descr Sps knee device
Coverage Carrier Priced
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
BETOS D1E – Other DME
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/2002
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 2
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
KI Dmepos item, second or third month rental
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KX Requirements specified in the medical policy have been met
KH Dmepos item, initial claim, purchase or first month rental
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
NU New equipment
Date
Action
Notes
2002-01-01 Added Code added 1/1/2002
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Description
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