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Official Description

Wheelchair accessory, dynamic positioning hardware for back
Short Descr Wc dynamic pos back hardware
Coverage Carrier Priced
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
BETOS D1D – Wheelchairs
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2020
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
OTS Orthotic No
KX Requirements specified in the medical policy have been met
NU New equipment
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
CR Catastrophe/disaster related
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
GZ Item or service expected to be denied as not reasonable and necessary
KM Replacement of facial prosthesis including new impression/moulage
KU Dmepos item subject to dmepos competitive bidding program number 3
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)
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
Date
Action
Notes
2024-01-01 Note Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)
2020-01-01 Added Code added.
Code
Description
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