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Official Description

Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each
Short Descr Tube, pneum wheel drive tire
Coverage Special coverage instructions apply
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
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 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
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)
Date
Action
Notes
2007-01-01 Added Code added 1/1/2007
Code
Description
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