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Official Description

Contact lens, hydrophilic, extended wear, per lens
Short Descr Cntct lens hydrophil extend
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
CIM 45-7
BETOS D1F – Prosthetic/Orthotic devices
TOS Code(s) Q – Vision items or services
Added Date 1/1/1985
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 2
MUE 2
IOM 100-03, 1, 80.1
OTS Orthotic No
CCS Clinical Classification 241 - Visual aids and other optical 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)
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
CR Catastrophe/disaster related
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
KX Requirements specified in the medical policy have been met
LR Laboratory round trip
RA Replacement of a dme, orthotic or prosthetic item
SG Ambulatory surgical center (asc) facility service
Date
Action
Notes
1985-01-01 Added Code added 1/1/1985
Code
Description
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