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Try CasePilot| Short Descr | Sup/ext non-ins inf pump syr | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 34 – Supplies And Surgical Dressings - DME supplies (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) | P – Lump sum purchase of DME, prosthetics, orthotics | Added Date | 7/1/2003 | APC Status Indicator | Non-Implantable Durable Medical Equipment | MUE | Not applicable/unspecified. | MUE | Not applicable/unspecified. | IOM | 100-03, 1, 50.3 | OTS Orthotic | No | CCS Clinical Classification | 243 - DME and supplies |
| KX | Requirements specified in the medical policy have been met | JB | Administered subcutaneously | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | CR | Catastrophe/disaster related | EY | No physician or other licensed health care provider order for this item or service | GX | Notice of liability issued, voluntary under payer policy | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GW | Service not related to the hospice patient's terminal condition | JZ | Zero drug amount discarded/not administered to any patient | SC | Medically necessary service or supply | SS | Home infusion services provided in the infusion suite of the iv therapy provider |
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| 2017-01-01 | Changed | Description Changed |
| 2003-07-01 | Added | Code added 7/1/2003 |
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