|
L2570 |
 |
Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each
| short | Hip clevis type 2 posit jnt |
| 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 |
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|
|
|
L2580 |
|
Addition to lower extremity, pelvic control, pelvic sling
| short | Pelvic control pelvic sling |
| 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 |
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|
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|
L2600 |
|
Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each
| short | Hip clevis/thrust bearing fr |
| 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 |
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|
|
|
L2610 |
|
Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each
| short | Hip clevis/thrust bearing lo |
| 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 |
|
|
|
|
L2620 |
|
Addition to lower extremity, pelvic control, hip joint, heavy duty, each
| short | Pelvic control hip heavy dut |
| 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 |
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|
|
|
L2622 |
|
Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each
| short | Hip joint adjustable flexion |
| 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 |
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|
|
|
L2624 |
|
Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each
| short | Hip adj flex ext abduct cont |
| 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 |
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|
|
|
L2627 |
|
Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables
| short | Plastic mold recipro hip & c |
| 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 | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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|
|
|
L2628 |
|
Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables
| short | Metal frame recipro hip & ca |
| 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 | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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|
|
|
L2630 |
|
Addition to lower extremity, pelvic control, band and belt, unilateral
| short | Pelvic control band & belt u |
| 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 |
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|
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L2640 |
|
Addition to lower extremity, pelvic control, band and belt, bilateral
| short | Pelvic control band & belt b |
| 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 |
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|
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L2650 |
|
Addition to lower extremity, pelvic and thoracic control, gluteal pad, each
| short | Pelv & thor control gluteal |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration | | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |
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|
|
|
L2660 |
|
Addition to lower extremity, thoracic control, thoracic band
| short | Thoracic control thoracic ba |
| 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 | Nature of Equipment | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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|
|
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L2670 |
|
Addition to lower extremity, thoracic control, paraspinal uprights
| short | Thorac cont paraspinal uprig |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
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L2680 |
|
Addition to lower extremity, thoracic control, lateral support uprights
| short | Thorac cont lat support upri |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
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