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K0455 |
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Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)
| short | Pump uninterrupted infusion |
| 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 |
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K0462 |
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Temporary replacement for patient owned equipment being repaired, any type
| short | Temporary replacement eqpmnt |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| 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 | Clinical: Data |
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K0552 |
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Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each
| short | Sup/ext non-ins inf pump syr |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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K0553 |
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Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
| short | Ther cgm supply allowance |
| 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 | Code Descriptor / CPT Instruction |
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K0554 |
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Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system
| short | Ther cgm receiver/monitor |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| 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 | Code Descriptor / CPT Instruction |
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K0601 |
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Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each
| short | Repl batt silver oxide 1.5 v |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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K0602 |
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Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each
| short | Repl batt silver oxide 3 v |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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K0603 |
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Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each
| short | Repl batt alkaline 1.5 v |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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K0604 |
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Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each
| short | Repl batt lithium 3.6 v |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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K0605 |
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Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each
| short | Repl batt lithium 4.5 v |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
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| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
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