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Official Description

Upper extremity addition, removable insert, each
Short Descr Removable insert each
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 1/1/1988
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
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)
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
1988-01-01 Added Code added 1/1/1988
Code
Description
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