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Official Description

Foot, insert, removable, molded to patient model, longitudinal arch support, each
Short Descr Foot longitudinal arch suppo
Coverage Special coverage instructions apply
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
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')
MCM 2323
BETOS D1F – Prosthetic/Orthotic devices
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/1982
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 0
MUE 2
IOM 100-02, 15, 290
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
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
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
KX Requirements specified in the medical policy have been met
GA Waiver of liability statement issued as required by payer policy, individual case
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
ER Items and services furnished by a provider-based, off-campus emergency department
EY No physician or other licensed health care provider order for this item or service
GP Services delivered under an outpatient physical therapy plan of care
GX Notice of liability issued, voluntary under payer policy
GZ Item or service expected to be denied as not reasonable and necessary
KY Dmepos item subject to dmepos competitive bidding program number 5
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
TA Left foot, great toe
Date
Action
Notes
1982-01-01 Added Code added 1/1/1982
Code
Description
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