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Official Description

Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment
Short Descr Oral dev without fix mech
Coverage Carrier Priced
Pricing Indicator(s) 99 – Value not established
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
BETOS Z2 – Undefined codes
TOS Code(s) 9 – Other medical items or services
Added Date 10/1/2021
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 1
MUE 1
OTS Orthotic No
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
KX Requirements specified in the medical policy have been met
NU New equipment
Date
Action
Notes
2022-01-01 Added First appearance in codebook.
2021-10-01 Added Code added.
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