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Official Description

Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue
Short Descr Expandable controller, initl
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
NU New equipment
KU Dmepos item subject to dmepos competitive bidding program number 3
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
KX Requirements specified in the medical policy have been met
RR Rental (use the 'rr' modifier when dme is to be rented)
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KI Dmepos item, second or third month rental
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
KH Dmepos item, initial claim, purchase or first month rental
UE Used durable medical equipment
GA Waiver of liability statement issued as required by payer policy, individual case
EY No physician or other licensed health care provider order for this item or service
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
KV Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
KY Dmepos item subject to dmepos competitive bidding program number 5
RA Replacement of a dme, orthotic or prosthetic item
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
Date
Action
Notes
2007-01-01 Added Code added 1/1/2007
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