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Official Description

Manual wheelchair accessory, caster fork, any size, replacement only, each
Short Descr Caster fork replacement only
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
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
KU Dmepos item subject to dmepos competitive bidding program number 3
KX Requirements specified in the medical policy have been met
GA Waiver of liability statement issued as required by payer policy, individual case
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
LT Left side (used to identify procedures performed on the left side of the body)
RR Rental (use the 'rr' modifier when dme is to be rented)
RT Right side (used to identify procedures performed on the right side of the body)
UE Used durable medical equipment
Date
Action
Notes
2006-01-01 Added Code added 1/1/2006
Code
Description
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