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Try CasePilot| Short Descr | So acro/clav can web pre ots | 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 | 1/1/1982 | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | MUE | Not applicable/unspecified. | MUE | Not applicable/unspecified. | OTS Orthotic | Yes | CCS Clinical Classification | 243 - DME and supplies |
| 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 | 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 | CR | Catastrophe/disaster related | CG | Policy criteria applied | J5 | Off-the-shelf orthotic subject to dmepos competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service | 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). | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | AY | Item or service furnished to an esrd patient that is not for the treatment of esrd | BP | The beneficiary has been informed of the purchase and rental options and has elected to purchase the item | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | EY | No physician or other licensed health care provider order for this item or service | F2 | Left hand, third digit | FY | X-ray taken using computed radiography technology/cassette-based imaging | GC | This service has been performed in part by a resident under the direction of a teaching physician | GL | Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) | GO | Services delivered under an outpatient occupational therapy plan of care | GP | Services delivered under an outpatient physical therapy plan of care | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | 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 | JZ | Zero drug amount discarded/not administered to any patient | KR | Rental item, billing for partial month | KS | Glucose monitor supply for diabetic beneficiary not treated with insulin | KT | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item | KY | Dmepos item subject to dmepos competitive bidding program number 5 | NU | New equipment | RA | Replacement of a dme, orthotic or prosthetic item | ST | Related to trauma or injury | T1 | Left foot, second digit | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2014-01-01 | Changed | Description Changed |
| 2011-01-01 | Deleted | Deleted |
| 2011-01-01 | ReActivated | This code was originally scheduled for deletion for January 1, 2011. However, on December 10, 2010, CMS issued a statement saying that it was reinstated. |
| 1982-01-01 | Added | Added |
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