K0903 HCPCS - 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

Code Information

HCPCS Code: K0903
Sequence Number: 0010
Short Description: Mult den insert dir carv/cam
Long Description: 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
Date Added: 4/1/2018
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2019
Classification: Temporary Codes for Durable Medical Equipment Regional Carriers
Coding System: HCPCS

Pricing Indicator Code:
- 38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
Coverage Issues Manual Reference Section Number:
N/A
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: C - Carrier judgment

Field Name	Field Value
Healthcare Common Procedure Coding System Code	K0903
HCPCS Sequence Number	0010
HCPCS Record Identification Code	3 - First line of procedure record also contains detail information in positions 92-275
HCPCS Long Description	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
HCPCS Short Description	Mult den insert dir carv/cam
HCPCS Pricing Indicator Code 1	38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Code	C - Carrier judgment
HCPCS Berenson-Eggers Type Of Service Code	D1F - Prosthetic/Orthotic devices
HCPCS Type Of Service Code 1	J - Diabetic shoes (eff 04/95)
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	4/1/2018
HCPCS Action Effective Date	1/1/2019
HCPCS Termination Date	12/31/2018
HCPCS Action Code	N - No maintenance for this code