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Official Description

Seat, contoured, for pediatric size wheelchair including fixed attaching hardware
Short Descr Contour seat for ped size wc
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 1/1/2005
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 1
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
GZ Item or service expected to be denied as not reasonable and necessary
KX Requirements specified in the medical policy have been met
NU New equipment
Date
Action
Notes
2005-01-01 Added Code added 1/1/2005
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