|
E0650 |
 |
Pneumatic compressor, non-segmental home model
| short | Pneuma compresor non-segment |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E0651 |
|
Pneumatic compressor, segmental home model without calibrated gradient pressure
| short | Pneum compressor segmental |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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|
|
|
E0652 |
|
Pneumatic compressor, segmental home model with calibrated gradient pressure
| short | Pneum compres w/cal pressure |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E0655 |
|
Non-segmental pneumatic appliance for use with pneumatic compressor, half arm
| short | Pneumatic appliance half arm |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0656 |
|
Segmental pneumatic appliance for use with pneumatic compressor, trunk
| short | Segmental pneumatic trunk |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
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|
|
|
E0657 |
|
Segmental pneumatic appliance for use with pneumatic compressor, chest
| short | Segmental pneumatic chest |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
E0660 |
|
Non-segmental pneumatic appliance for use with pneumatic compressor, full leg
| short | Pneumatic appliance full leg |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0665 |
|
Non-segmental pneumatic appliance for use with pneumatic compressor, full arm
| short | Pneumatic appliance full arm |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0666 |
|
Non-segmental pneumatic appliance for use with pneumatic compressor, half leg
| short | Pneumatic appliance half leg |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0667 |
|
Segmental pneumatic appliance for use with pneumatic compressor, full leg
| short | Seg pneumatic appl full leg |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0668 |
|
Segmental pneumatic appliance for use with pneumatic compressor, full arm
| short | Seg pneumatic appl full arm |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0669 |
|
Segmental pneumatic appliance for use with pneumatic compressor, half leg
| short | Seg pneumatic appli half leg |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0670 |
|
Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk
| short | Seg pneum int legs/trunk |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
E0671 |
|
Segmental gradient pressure pneumatic appliance, full leg
| short | Pressure pneum appl full leg |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0672 |
|
Segmental gradient pressure pneumatic appliance, full arm
| short | Pressure pneum appl full arm |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0673 |
|
Segmental gradient pressure pneumatic appliance, half leg
| short | Pressure pneum appl half leg |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E0675 |
|
Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system)
| short | Pneumatic compression device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E0676 |
|
Intermittent limb compression device (includes all accessories), not otherwise specified
| short | Inter limb compress dev nos |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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