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Official Description

Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Short Descr Ho bi thighcuffs w sprdr bar
Coverage Carrier Priced
Pricing Indicator(s) 38 – Supplies And Surgical Dressings - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1F – Prosthetic/Orthotic devices
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/2003
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
GW Service not related to the hospice patient's terminal condition
EY No physician or other licensed health care provider order for this item or service
GA Waiver of liability statement issued as required by payer policy, individual case
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
RA Replacement of a dme, orthotic or prosthetic item
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
2025-01-01 Changed First appearance of change in codebook.
2024-10-01 Changed Code changed. Change in long description.
2003-01-01 Added Code added 1/1/2003
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