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Official Description

Replacement soft interface material, dynamic adjustable extension/flexion device
Short Descr Soft interface material
Coverage Carrier Priced
Pricing Indicator(s) 32 – Supplies And Surgical Dressings - Inexpensive & routinely purchased 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 1/1/1996
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 2
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
NU New equipment
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
1996-01-01 Added Code added 1/1/1996
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