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Official Description

Fixed, adjustable height armrest, pair
Short Descr Fixed adjust armrest pair
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 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
RR Rental (use the 'rr' modifier when dme is to be rented)
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
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)
NU New equipment
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
1994-01-01 Added Code added 1/1/1994
Code
Description
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