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Official Description

Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds
Short Descr Pov group 1 std up to 300lbs
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 10/1/2006
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
NU New equipment
RR Rental (use the 'rr' modifier when dme is to be rented)
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
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
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
GK Reasonable and necessary item/service associated with a ga or gz modifier
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
GW Service not related to the hospice patient's terminal condition
KH Dmepos item, initial claim, purchase or first month rental
KY Dmepos item subject to dmepos competitive bidding program number 5
NB Nebulizer system, any type, fda-cleared for use with specific drug
RA Replacement of a dme, orthotic or prosthetic item
UE Used durable medical equipment
Date
Action
Notes
2006-10-01 Added Code added 10/1/2006
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