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Official Description

Replacement cover for wheelchair seat cushion or back cushion, each
Short Descr Replace cover w/c seat cush
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 1/1/2005
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
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
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
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
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
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)
Date
Action
Notes
2005-01-01 Added Code added 1/1/2005
Code
Description
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