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Official Description

Custom motorized/power wheelchair base
Short Descr Custom power whlchr base
Coverage Special coverage instructions apply
Pricing Indicator(s) 45 – Supplies And Surgical Dressings - Customized DME items
MPI A – Not applicable, as HCPCS priced under one methodology
Processing Note PUB. 100-04 CH. 20 S. 30.3.
BETOS D1D – Wheelchairs
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 7/1/2013
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
NU New equipment
Date
Action
Notes
2013-07-01 ReActivated Reactivated
2013-07-01 Added Added
2001-07-01 Deleted Deleted
1994-01-01 Added Added
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