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Official Description

Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds
Short Descr Pwc gp3 hd sing 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
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
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
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
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)
UE Used durable medical equipment
Date
Action
Notes
2006-10-01 Added Code added 10/1/2006
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