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Official Description

Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)
Short Descr Pump uninterrupted infusion
Coverage Special coverage instructions apply
Pricing Indicator(s) 31 – Supplies And Surgical Dressings - Frequently serviced DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
CIM 60-14
BETOS D1E – Other DME
TOS Code(s) R – Rental of DME
Added Date 1/1/1998
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
IOM 100-03, 1, 50.3
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
KX Requirements specified in the medical policy have been met
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
HH Integrated mental health/substance abuse program
HN Bachelors degree level
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
Date
Action
Notes
1998-01-01 Added Code added 1/1/1998
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