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Official Description

Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes
Short Descr Repair/svc dme non-oxygen eq
Coverage Carrier Priced
Pricing Indicator(s) 46 – Supplies And Surgical Dressings - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1E – Other DME
TOS Code(s) 9 – Other medical items or services
Added Date 4/1/2009
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE Not applicable/unspecified.
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
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
KX Requirements specified in the medical policy have been met
GA Waiver of liability statement issued as required by payer policy, individual case
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
GZ Item or service expected to be denied as not reasonable and necessary
GW Service not related to the hospice patient's terminal condition
GX Notice of liability issued, voluntary under payer policy
EY No physician or other licensed health care provider order for this item or service
RA Replacement of a dme, orthotic or prosthetic item
CR Catastrophe/disaster related
U1 Medicaid level of care 1, as defined by each state
BR The beneficiary has been informed of the purchase and rental options and has elected to rent the item
GG Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
HY Funded by juvenile justice agency
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KU Dmepos item subject to dmepos competitive bidding program number 3
LT Left side (used to identify procedures performed on the left side of the body)
N1 Group 1 oxygen coverage criteria met
NU New equipment
PO Excepted service provided at an off-campus, outpatient, provider-based department of a hospital
RT Right side (used to identify procedures performed on the right side of the body)
TW Back-up equipment
U2 Medicaid level of care 2, as defined by each state
U3 Medicaid level of care 3, as defined by each state
U5 Medicaid level of care 5, as defined by each state
U7 Medicaid level of care 7, as defined by each state
UB Medicaid level of care 11, as defined by each state
Date
Action
Notes
2009-04-01 Added -
Code
Description
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