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Official Description

Temporary replacement for patient owned equipment being repaired, any type
Short Descr Temporary replacement eqpmnt
Coverage Special coverage instructions apply
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
MCM 5102.3
BETOS D1E – Other DME
TOS Code(s) 9 – Other medical items or services
Added Date 7/1/1998
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
IOM 100-04, 20, 40.1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
CR Catastrophe/disaster related
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
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
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
RA Replacement of a dme, orthotic or prosthetic item
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
RR Rental (use the 'rr' modifier when dme is to be rented)
Date
Action
Notes
1998-07-01 Added Code added 7/1/1998
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