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Official Description

Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only
Short Descr Carbon graphite lamination
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 1/1/1997
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 0
MUE 8
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
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)
RT Right side (used to identify procedures performed on the right side of the body)
GA Waiver of liability statement issued as required by payer policy, individual case
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GP Services delivered under an outpatient physical therapy plan of care
GW Service not related to the hospice patient's terminal condition
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
KV Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
RA Replacement of a dme, orthotic or prosthetic item
Date
Action
Notes
1997-01-01 Added Code added 1/1/1997
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