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Official Description

Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment
Short Descr Ho w/o joints cf
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 1/1/2006
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 0
MUE 2
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
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)
KX Requirements specified in the medical policy have been met
GP Services delivered under an outpatient physical therapy plan of care
GA Waiver of liability statement issued as required by payer policy, individual case
GO Services delivered under an outpatient occupational therapy plan of care
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).
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CG Policy criteria applied
CO Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
F1 Left hand, second digit
F2 Left hand, third digit
F5 Right hand, thumb
F6 Right hand, second digit
F7 Right hand, third digit
FA Left hand, thumb
GW Service not related to the hospice patient's terminal condition
KV Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2006-01-01 Added Code added 1/1/2006
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Description
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