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Official Description

Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only
Short Descr Non-expandable controller
Coverage Special coverage instructions apply
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
Processing Note NCD MANUAL 280.1.
BETOS D1D – Wheelchairs
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2007
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
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
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
RR Rental (use the 'rr' modifier when dme is to be rented)
KX Requirements specified in the medical policy have been met
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
EB Erythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer radiotherapy
GA Waiver of liability statement issued as required by payer policy, individual case
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KU Dmepos item subject to dmepos competitive bidding program number 3
RA Replacement of a dme, orthotic or prosthetic item
Date
Action
Notes
2007-01-01 Added Code added 1/1/2007
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