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Official Description

Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf
Short Descr So vest canvas/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 1/1/1999
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
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
RT Right side (used to identify procedures performed on the right side of the body)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
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
Date
Action
Notes
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.
1999-01-01 Added Added
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Description
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