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Official Description

Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each
Short Descr Pneumatic prop tire insert
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 1/1/2006
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 2
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
NU New equipment
KU Dmepos item subject to dmepos competitive bidding program number 3
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
KY Dmepos item subject to dmepos competitive bidding program number 5
RT Right side (used to identify procedures performed on the right side of the body)
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
RR Rental (use the 'rr' modifier when dme is to be rented)
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
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
UE Used durable medical equipment
Date
Action
Notes
2006-01-01 Added Code added 1/1/2006
Code
Description
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