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Official Description

Manual wheelchair accessory, foam filled caster tire, any size, each
Short Descr Foam filled caster tire each
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
KU Dmepos item subject to dmepos competitive bidding program number 3
KX Requirements specified in the medical policy have been met
KY Dmepos item subject to dmepos competitive bidding program number 5
LT Left side (used to identify procedures performed on the left side of the body)
NU New equipment
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)
Date
Action
Notes
2006-01-01 Added Code added 1/1/2006
Code
Description
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