|
L8040 |
 |
Nasal prosthesis, provided by a non-physician
| short | Nasal prosthesis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
L8041 |
|
Midfacial prosthesis, provided by a non-physician
| short | Midfacial prosthesis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
L8042 |
|
Orbital prosthesis, provided by a non-physician
| short | Orbital prosthesis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
L8043 |
|
Upper facial prosthesis, provided by a non-physician
| short | Upper facial prosthesis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
L8044 |
|
Hemi-facial prosthesis, provided by a non-physician
| short | Hemi-facial prosthesis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
L8045 |
|
Auricular prosthesis, provided by a non-physician
| short | Auricular prosthesis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
L8046 |
|
Partial facial prosthesis, provided by a non-physician
| short | Partial facial prosthesis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration | | DME | 1.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
|
|
|
|
L8047 |
|
Nasal septal prosthesis, provided by a non-physician
| short | Nasal septal prosthesis |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 1.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
L8048 |
|
Unspecified maxillofacial prosthesis, by report, provided by a non-physician
| short | Unspec maxillofacial prosth |
| 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 |
|
|
|
|
L8049 |
|
Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician
| short | Repair maxillofacial prosth |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|