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Try CasePilot| Short Descr | Breast prosthesis bra & form | Coverage | Special coverage instructions apply | 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 | MCM | 2130A | BETOS | D1F – Prosthetic/Orthotic devices | TOS Code(s) | P – Lump sum purchase of DME, prosthetics, orthotics | Added Date | 1/1/2002 | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | MUE | 0 | MUE | 4 | IOM | 100-02, 15, 120 | 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 | BP | The beneficiary has been informed of the purchase and rental options and has elected to purchase the item |
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| 2013-01-01 | Changed | Description Changed |
| 2002-01-01 | Added | Code added 1/1/2002 |
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