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Try CasePilot| Short Descr | Breast prosthes w/o adhesive | 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 | 2130 A | BETOS | D1F – Prosthetic/Orthotic devices | TOS Code(s) | P – Lump sum purchase of DME, prosthetics, orthotics | Added Date | 1/1/1989 | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | MUE | 0 | MUE | 2 | IOM | 100-02, 15, 120 | 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) | KX | Requirements specified in the medical policy have been met | GA | Waiver of liability statement issued as required by payer policy, individual case | RA | Replacement of a dme, orthotic or prosthetic item | CR | Catastrophe/disaster related | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GK | Reasonable and necessary item/service associated with a ga or gz modifier | 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 | KT | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item | KY | Dmepos item subject to dmepos competitive bidding program number 5 | LS | Fda-monitored intraocular lens implant | M2 | Medicare secondary payer (msp) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RB | Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair |
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| 2010-01-01 | Changed | Code description changed |
| 1989-01-01 | Added | Code added 1/1/1989 |
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