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Official Description

Standard wheelchair
Short Descr Standard wheelchair
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) R – Rental of DME
Added Date 1/1/1994
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KI Dmepos item, second or third month rental
KH Dmepos item, initial claim, purchase or first month rental
KX Requirements specified in the medical policy have been met
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
GZ Item or service expected to be denied as not reasonable and necessary
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
MS Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
NU New equipment
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
CR Catastrophe/disaster related
EY No physician or other licensed health care provider order for this item or service
GK Reasonable and necessary item/service associated with a ga or gz modifier
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
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
LL Lease/rental (use the 'll' modifier when dme equipment rental is to be applied against the purchase price)
N1 Group 1 oxygen coverage criteria met
QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
RA Replacement of a dme, orthotic or prosthetic item
TT Individualized service provided to more than one patient in same setting
UE Used durable medical equipment
Date
Action
Notes
1994-01-01 Added Code added 1/1/1994
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