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Official Description

High strength, lightweight wheelchair
Short Descr High strength ltwt whlchr
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
GZ Item or service expected to be denied as not reasonable and necessary
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
NU New equipment
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
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
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)
MS Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
Date
Action
Notes
1994-01-01 Added Code added 1/1/1994
Code
Description
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