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Official Description

Power wheelchair component, actuator, replacement only
Short Descr Pw actuator replacement
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 1/1/2013
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
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)
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
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
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KY Dmepos item subject to dmepos competitive bidding program number 5
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
UE Used durable medical equipment
Date
Action
Notes
2013-01-01 Added Added
Code
Description
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