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Official Description

Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each
Short Descr Insert, pneum wheel drive
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
RT Right side (used to identify procedures performed on the right side of the body)
KU Dmepos item subject to dmepos competitive bidding program number 3
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
LT Left side (used to identify procedures performed on the left side of the body)
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
KA Add on option/accessory for wheelchair
KX Requirements specified in the medical policy have been met
Date
Action
Notes
2007-01-01 Added Code added 1/1/2007
Code
Description
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