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Official Description

Power wheelchair component, drive wheel gear box, replacement only
Short Descr Pwr wc drivewheel gear repl
Coverage Carrier Priced
Pricing Indicator(s) 36 – Supplies And Surgical Dressings - Capped rental 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 0
MUE 2
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
NU New equipment
UE Used durable medical equipment
KX Requirements specified in the medical policy have been met
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KU Dmepos item subject to dmepos competitive bidding program number 3
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)
Date
Action
Notes
2013-01-01 Changed Description Changed
2005-01-01 Added Code added 1/1/2005
Code
Description
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