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Try CasePilot| Short Descr | Prosthetic device repair rep | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 46 – Supplies And Surgical Dressings - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts) | MPI | A – Not applicable, as HCPCS priced under one methodology | MCM | 2100.4 | BETOS | D1F – Prosthetic/Orthotic devices | TOS Code(s) | P – Lump sum purchase of DME, prosthetics, orthotics | Added Date | 1/1/1985 | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | MUE | 4 | MUE | 4 | IOM | 100-02, 15, 110.2 | OTS Orthotic | No | 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) | K3 | Lower extremity prosthesis functional level 3 - has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. | KX | Requirements specified in the medical policy have been met | RB | Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair | RA | Replacement of a dme, orthotic or prosthetic item | K2 | Lower extremity prosthesis functional level 2 - has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. typical of the limited community ambulator. | K4 | Lower extremity prosthesis functional level 4 - has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | K1 | Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator. | NU | New equipment |
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| 1985-01-01 | Added | Code added 1/1/1985 |
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