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Official Description

Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
Short Descr Pwc gp2 hd mult pow opt s/b
Coverage Carrier Priced
Pricing Indicator(s) 36 – Supplies And Surgical Dressings - Capped rental 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
NU New equipment
KX Requirements specified in the medical policy have been met
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
RR Rental (use the 'rr' modifier when dme is to be rented)
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
KY Dmepos item subject to dmepos competitive bidding program number 5
UE Used durable medical equipment
Date
Action
Notes
2006-10-01 Added Code added 10/1/2006
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