K0 |
Lwr ext prost functnl lvl 0 |
Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. |
K0001 |
Standard wheelchair |
Standard wheelchair |
K0002 |
Stnd hemi (low seat) whlchr |
Standard hemi (low seat) wheelchair |
K0003 |
Lightweight wheelchair |
Lightweight wheelchair |
K0004 |
High strength ltwt whlchr |
High strength, lightweight wheelchair |
K0005 |
Ultralightweight wheelchair |
Ultralightweight wheelchair |
K0006 |
Heavy duty wheelchair |
Heavy duty wheelchair |
K0007 |
Extra heavy duty wheelchair |
Extra heavy duty wheelchair |
K0008 |
Cstm manual wheelchair/base |
Custom manual wheelchair/base |
K0009 |
Other manual wheelchair/base |
Other manual wheelchair/base |
K0010 |
Stnd wt frame power whlchr |
Standard - weight frame motorized/power wheelchair |
K0011 |
Stnd wt pwr whlchr w control |
Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking |
K0012 |
Ltwt portbl power whlchr |
Lightweight portable motorized/power wheelchair |
K0013 |
Custom power whlchr base |
Custom motorized/power wheelchair base |
K0014 |
Other power whlchr base |
Other motorized/power wheelchair base |
K0015 |
Detach non-adj ht armrst rep |
Detachable, non-adjustable height armrest, replacement only, each |
K0017 |
Detach adjust armrest base |
Detachable, adjustable height armrest, base, replacement only, each |
K0018 |
Detach adjust armrst upper |
Detachable, adjustable height armrest, upper portion, replacement only, each |
K0019 |
Arm pad repl, each |
Arm pad, replacement only, each |
K0020 |
Fixed adjust armrest pair |
Fixed, adjustable height armrest, pair |
K0037 |
Hi mount flip-up footrest ea |
High mount flip-up footrest, each |
K0038 |
Leg strap each |
Leg strap, each |
K0039 |
Leg strap h style each |
Leg strap, h style, each |
K0040 |
Adjustable angle footplate |
Adjustable angle footplate, each |
K0041 |
Large size footplate each |
Large size footplate, each |
K0042 |
Standard size ftplate rep ea |
Standard size footplate, replacement only, each |
K0043 |
Ftrst lowr exten tube rep ea |
Footrest, lower extension tube, replacement only, each |
K0044 |
Ftrst upr hanger brac rep ea |
Footrest, upper hanger bracket, replacement only, each |
K0045 |
Ftrst compl assembly repl ea |
Footrest, complete assembly, replacement only, each |
K0046 |
Elev lgrst lwr exten repl ea |
Elevating legrest, lower extension tube, replacement only, each |
K0047 |
Elev legrst upr hangr rep ea |
Elevating legrest, upper hanger bracket, replacement only, each |
K0050 |
Ratchet assembly replacement |
Ratchet assembly, replacement only |
K0051 |
Cam rel asm ft/legrst rep ea |
Cam release assembly, footrest or legrest, replacement only, each |
K0052 |
Swingaway detach ftrest repl |
Swingaway, detachable footrests, replacement only, each |
K0053 |
Elevate footrest articulate |
Elevating footrests, articulating (telescoping), each |
K0056 |
Seat ht <17 or >=21 ltwt wc |
Seat height less than 17 or equal to or greater than 21 for a high strength, lightweight, or ultralightweight wheelchair |
K0065 |
Spoke protectors |
Spoke protectors, each |
K0069 |
Rr whl compl sol tire rep ea |
Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each |
K0070 |
Rr whl compl pne tire rep ea |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
K0071 |
Fr cstr comp pne tire rep ea |
Front caster assembly, complete, with pneumatic tire, replacement only, each |
K0072 |
Fr cstr semi-pne tire rep ea |
Front caster assembly, complete, with semi-pneumatic tire, replacement only, each |
K0073 |
Caster pin lock each |
Caster pin lock, each |
K0077 |
Fr cstr asmb sol tire rep ea |
Front caster assembly, complete, with solid tire, replacement only, each |
K0098 |
Drive belt for pwc, repl |
Drive belt for power wheelchair, replacement only |
K0105 |
Iv hanger |
Iv hanger, each |
K0108 |
W/c component-accessory nos |
Wheelchair component or accessory, not otherwise specified |
K0195 |
Elevating whlchair leg rests |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
K0455 |
Pump uninterrupted infusion |
Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol) |
K0462 |
Temporary replacement eqpmnt |
Temporary replacement for patient owned equipment being repaired, any type |
K0552 |
Sup/ext non-ins inf pump syr |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
K0553 |
Ther cgm supply allowance |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
K0554 |
Ther cgm receiver/monitor |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
K0601 |
Repl batt silver oxide 1.5 v |
Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each |
K0602 |
Repl batt silver oxide 3 v |
Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each |
K0603 |
Repl batt alkaline 1.5 v |
Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each |
K0604 |
Repl batt lithium 3.6 v |
Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each |
K0605 |
Repl batt lithium 4.5 v |
Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each |
K0606 |
Aed garment w elec analysis |
Automatic external defibrillator, with integrated electrocardiogram analysis, garment type |
K0607 |
Repl batt for aed |
Replacement battery for automated external defibrillator, garment type only, each |
K0608 |
Repl garment for aed |
Replacement garment for use with automated external defibrillator, each |
K0609 |
Repl electrode for aed |
Replacement electrodes for use with automated external defibrillator, garment type only, each |
K0669 |
Seat/back cus no dmepdac ver |
Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac |
K0672 |
Removable soft interface le |
Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each |
K0730 |
Ctrl dose inh drug deliv sys |
Controlled dose inhalation drug delivery system |
K0733 |
12-24hr sealed lead acid |
Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
K0738 |
Portable gas oxygen system |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
K0739 |
Repair/svc dme non-oxygen eq |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
K0740 |
Repair/svc oxygen equipment |
Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
K0743 |
Portable home suction pump |
Suction pump, home model, portable, for use on wounds |
K0744 |
Absorp drg <= 16 suc pump |
Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less |
K0745 |
Absorp drg >16<=48 suc pump |
Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches |
K0746 |
Absorp drg >48 suc pump |
Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches |
K0800 |
Pov group 1 std up to 300lbs |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
K0801 |
Pov group 1 hd 301-450 lbs |
Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds |
K0802 |
Pov group 1 vhd 451-600 lbs |
Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds |
K0806 |
Pov group 2 std up to 300lbs |
Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds |
K0807 |
Pov group 2 hd 301-450 lbs |
Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds |
K0808 |
Pov group 2 vhd 451-600 lbs |
Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds |
K0812 |
Power operated vehicle noc |
Power operated vehicle, not otherwise classified |
K0813 |
Pwc gp 1 std port seat/back |
Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
K0814 |
Pwc gp 1 std port cap chair |
Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
K0815 |
Pwc gp 1 std seat/back |
Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
K0816 |
Pwc gp 1 std cap chair |
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
K0820 |
Pwc gp 2 std port seat/back |
Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0821 |
Pwc gp 2 std port cap chair |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
K0822 |
Pwc gp 2 std seat/back |
Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0823 |
Pwc gp 2 std cap chair |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
K0824 |
Pwc gp 2 hd seat/back |
Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
K0825 |
Pwc gp 2 hd cap chair |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
K0826 |
Pwc gp 2 vhd seat/back |
Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
K0827 |
Pwc gp vhd cap chair |
Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds |
K0828 |
Pwc gp 2 xtra hd seat/back |
Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more |
K0829 |
Pwc gp 2 xtra hd cap chair |
Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more |
K0830 |
Pwc gp2 std seat elevate s/b |
Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0831 |
Pwc gp2 std seat elevate cap |
Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds |
K0835 |
Pwc gp2 std sing pow opt s/b |
Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0836 |
Pwc gp2 std sing pow opt cap |
Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds |
K0837 |
Pwc gp 2 hd sing pow opt s/b |
Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
K0838 |
Pwc gp 2 hd sing pow opt cap |
Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds |
K0839 |
Pwc gp2 vhd sing pow opt s/b |
Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
K0840 |
Pwc gp2 xhd sing pow opt s/b |
Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more |
K0841 |
Pwc gp2 std mult pow opt s/b |
Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0842 |
Pwc gp2 std mult pow opt cap |
Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds |
K0843 |
Pwc gp2 hd mult pow opt s/b |
Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
K0848 |
Pwc gp 3 std seat/back |
Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0849 |
Pwc gp 3 std cap chair |
Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds |
K0850 |
Pwc gp 3 hd seat/back |
Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
K0851 |
Pwc gp 3 hd cap chair |
Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
K0852 |
Pwc gp 3 vhd seat/back |
Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
K0853 |
Pwc gp 3 vhd cap chair |
Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds |
K0854 |
Pwc gp 3 xhd seat/back |
Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more |
K0855 |
Pwc gp 3 xhd cap chair |
Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more |
K0856 |
Pwc gp3 std sing pow opt s/b |
Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0857 |
Pwc gp3 std sing pow opt cap |
Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds |
K0858 |
Pwc gp3 hd sing pow opt s/b |
Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds |
K0859 |
Pwc gp3 hd sing pow opt cap |
Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds |
K0860 |
Pwc gp3 vhd sing pow opt s/b |
Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
K0861 |
Pwc gp3 std mult pow opt s/b |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0862 |
Pwc gp3 hd mult pow opt s/b |
Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
K0863 |
Pwc gp3 vhd mult pow opt s/b |
Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
K0864 |
Pwc gp3 xhd mult pow opt s/b |
Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more |
K0868 |
Pwc gp 4 std seat/back |
Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0869 |
Pwc gp 4 std cap chair |
Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds |
K0870 |
Pwc gp 4 hd seat/back |
Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
K0871 |
Pwc gp 4 vhd seat/back |
Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
K0877 |
Pwc gp4 std sing pow opt s/b |
Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0878 |
Pwc gp4 std sing pow opt cap |
Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds |
K0879 |
Pwc gp4 hd sing pow opt s/b |
Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
K0880 |
Pwc gp4 vhd sing pow opt s/b |
Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds |
K0884 |
Pwc gp4 std mult pow opt s/b |
Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
K0885 |
Pwc gp4 std mult pow opt cap |
Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds |
K0886 |
Pwc gp4 hd mult pow s/b |
Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
K0890 |
Pwc gp5 ped sing pow opt s/b |
Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds |
K0891 |
Pwc gp5 ped mult pow opt s/b |
Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds |
K0898 |
Power wheelchair noc |
Power wheelchair, not otherwise classified |
K0899 |
Pow mobil dev no dmepdac |
Power mobility device, not coded by dme pdac or does not meet criteria |
K0900 |
Cstm dme other than wheelchr |
Customized durable medical equipment, other than wheelchair |
K0901 |
Ko single upright pre ots |
Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf |
K0902 |
Ko double upright pre ots |
Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf |
K0903 |
Mult den insert dir carv/cam |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
K1 |
Lwr ext prost functnl lvl 1 |
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. |
K1001 |
Electronic posa treatment |
Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type |
K1002 |
Ces system |
Cranial electrotherapy stimulation (ces) system, any type |
K1003 |
Whirlpool tub walkin portabl |
Whirlpool tub, walk-in, portable |
K1004 |
Lo freq us diathermy device |
Low frequency ultrasonic diathermy treatment device for home use |
K1005 |
Disp col sto bag breast milk |
Disposable collection and storage bag for breast milk, any size, any type, each |
K1006 |
Suct pum ext urine mgmt sys |
Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system |
K1007 |
Bil hkaf pc s/d micro sensor |
Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors |
K1009 |
Speech volume modulation sys |
Speech volume modulation system, any type, including all components and accessories |
K1010 |
Intraurethral drainag device |
Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each |
K1011 |
Acti intraurethral drainage |
Activation device for intraurethral drainage device with valve, replacement only, each |
K1012 |
Charger base station intraur |
Charger and base station for intraurethral activation device, replacement only |
K1013 |
Enema tube any type repl |
Enema tube, with or without adapter, any type, replacement only, each |
K1014 |
Ak 4 bar link hydl swg/stanc |
Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control |
K1015 |
Foot, adductus position, adj |
Foot, adductus positioning device, adjustable |
K1016 |
Trans elec nerv for trigemin |
Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve |
K1017 |
Monthly supp use with k1016 |
Monthly supplies for use of device coded at k1016 |
K1018 |
Ext up limb tremor stim wris |
External upper limb tremor stimulator of the peripheral nerves of the wrist |
K1019 |
Supp ext up limb tremor stim |
Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist |
K1020 |
Non-invasive vagus nerv stim |
Non-invasive vagus nerve stimulator |
K1021 |
Exsuff belt incl all sup acc |
Exsufflation belt, includes all supplies and accessories |
K1022 |
Endoskel posit rotat unit |
Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type |
K1023 |
Trans elec nerv periph nerv |
Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm |
K1024 |
Non pneum comp control cal |
Non-pneumatic compression controller with sequential calibrated gradient pressure |
K1025 |
Non pneum compress full arm |
Non-pneumatic sequential compression garment, full arm |
K1026 |
Mech allergen parti barrier |
Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical |
K1027 |
Oral dev without fix mech |
Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment |
K1028 |
Control unit nm stim w phone |
Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application |
K1029 |
Oral dv/app neuromus mouthpi |
Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply |
K1030 |
Ext recharge bat replacement |
External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only |
K1031 |
Non pneu comp control w/o ca |
Non-pneumatic compression controller without calibrated gradient pressure |
K1032 |
Non pneum seq comp full leg |
Non-pneumatic sequential compression garment, full leg |
K1033 |
Non pneum seq comp half leg |
Non-pneumatic sequential compression garment, half leg |
K1034 |
Covid test self-admn/collect |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
K1035 |
Mol diag reader self-admn |
Molecular diagnostic test reader, nonprescription self-administered and self-collected use, fda approved, authorized or cleared |
K1036 |
Supplies for ultra diatherm |
Supplies and accessories (e.g., transducer) for low frequency ultrasonic diathermy treatment device, per month |
K1037 |
Docking station for oral dev |
Docking station for use with oral device/appliance used to reduce upper airway collapsibility |
K2 |
Lwr ext prost functnl lvl 2 |
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. |
K3 |
Lwr ext prost functnl lvl 3 |
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. |
K4 |
Lwr ext prost functnl lvl 4 |
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. |
KA |
Wheelchair add-on option/acc |
Add on option/accessory for wheelchair |
KB |
>4 modifiers on claim |
Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim |
KC |
Repl special pwr wc intrface |
Replacement of special power wheelchair interface |
KD |
Drug/biological dme infused |
Drug or biological infused through dme |
KE |
Bid under round 1 dmepos cb |
Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment |
KF |
Fda class iii device |
Item designated by fda as class iii device |
KG |
Dmepos comp bid prgm no 1 |
Dmepos item subject to dmepos competitive bidding program number 1 |
KH |
Dmepos ini clm, pur/1 mo rnt |
Dmepos item, initial claim, purchase or first month rental |
KI |
Dmepos 2nd or 3rd mo rental |
Dmepos item, second or third month rental |
KJ |
Dmepos pen pmp or 4-15mo rnt |
Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen |
KK |
Dmepos comp bid prgm no 2 |
Dmepos item subject to dmepos competitive bidding program number 2 |
KL |
Dmepos mailorder comp bid |
Dmepos item delivered via mail |
KM |
Rplc facial prosth new imp |
Replacement of facial prosthesis including new impression/moulage |
KN |
Rplc facial prosth old mod |
Replacement of facial prosthesis using previous master model |
KO |
Single drug unit dose form |
Single drug unit dose formulation |
KP |
First drug of multi drug u d |
First drug of a multiple drug unit dose formulation |
KQ |
2nd/subsqnt drg multi drg ud |
Second or subsequent drug of a multiple drug unit dose formulation |
KR |
Rental item partial month |
Rental item, billing for partial month |
KS |
Glucose monitor supply |
Glucose monitor supply for diabetic beneficiary not treated with insulin |
KT |
Item from noncontract supply |
Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item |
KU |
Dmepos comp bid prgm no 3 |
Dmepos item subject to dmepos competitive bidding program number 3 |
KV |
Dmepos item, profession serv |
Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service |
KW |
Dmepos comp bid prgm no 4 |
Dmepos item subject to dmepos competitive bidding program number 4 |
KX |
Documentation on file |
Requirements specified in the medical policy have been met |
KY |
Dmepos comp bid prgm no 5 |
Dmepos item subject to dmepos competitive bidding program number 5 |
KZ |
New cov not implement by m+c |
New coverage not implemented by managed care |