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Official Description

Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches
Short Descr Man w/ch acc seat w>=20"<24"
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 D1D – Wheelchairs
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2004
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
RR Rental (use the 'rr' modifier when dme is to be rented)
NU New equipment
KU Dmepos item subject to dmepos competitive bidding program number 3
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
KY Dmepos item subject to dmepos competitive bidding program number 5
GA Waiver of liability statement issued as required by payer policy, individual case
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
EY No physician or other licensed health care provider order for this item or service
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
RT Right side (used to identify procedures performed on the right side of the body)
TW Back-up equipment
Date
Action
Notes
2004-01-01 Added Code added 1/1/2004
Code
Description
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