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Official Description

Arm pad, replacement only, each
Short Descr Arm pad repl, each
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 1/1/1994
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
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
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
KY Dmepos item subject to dmepos competitive bidding program number 5
RR Rental (use the 'rr' modifier when dme is to be rented)
BU The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision
GA Waiver of liability statement issued as required by payer policy, individual case
GZ Item or service expected to be denied as not reasonable and necessary
KH Dmepos item, initial claim, purchase or first month rental
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
UE Used durable medical equipment
Date
Action
Notes
2017-01-01 Changed Description Changed
1994-01-01 Added Code added 1/1/1994
Code
Description
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