J-20 DME List.pdf

CPT Code Service Description Description Parameters for Use

A0425 Ground mileage, per statute mile

Basic Life Support/Emergency Svc.

Medical Director Approval

A0426

Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)

Basic Life Support/Emergency Svc.

Medical Director Approval

A0429

Ambulance service, basic life support, emergency transport

Basic Life Support/Emergency Svc.

Medical Director Approval

A0999 Unlisted ambulance service Basic Life Support/Emergency Svc.

Medical Director Approval

A6530- A6549 Compression Stockings Medical Supplies

Treatment of WTC related musculoskeletal condition

A4617 Mouthpiece Oxygen & Supplies

Treatment of WTC related respiratory condition

A7003

Adminstration set, with small volume nonfiltered pneumatic nebulizer, disposable Nebulizer & Supplies

Treatment of WTC related respiratory condition

A7004

Small volume nonfiltered pnematic nebulizer, disposable Nebulizer & Supplies

Treatment of WTC related respiratory condition

A7005

Adminstration set, with small , volume nonfiltered pneumatic nebulizer, nondisposable Nebulizer & Supplies

Treatment of WTC related respiratory condition

A7013 Filter, disposable, used with aerosol compressor Nebulizer & Supplies

Treatment of WTC related respiratory condition

A7015 Aerosol mask, used with DME nebulizer Nebulizer & Supplies

Treatment of WTC related respiratory condition

A7029

Nasal pillows for combination oral/nasal mask, replacement only, pair CPAP & Supplies

Treatment of WTC related respiratory condition

A7030

Full face mask used with positive airway pressure device CPAP & Supplies

Treatment of WTC related respiratory condition

A7031

Face mask interface, replacement for full face mask, each CPAP & Supplies

Treatment of WTC related respiratory condition

A7032

Cushion for use on nasal mask interface, replacement only CPAP & Supplies

Treatment of WTC related respiratory condition

A7033

Pillow for use on nasal cannula type interface, replacement only, pair CPAP & Supplies

Treatment of WTC related respiratory condition

A7034

Nasal interface used with positive airway pressure device, with or without head strap CPAP & Supplies

Treatment of WTC related respiratory condition

A7035 Headgear used with positive airway pressure device CPAP & Supplies

Treatment of WTC related respiratory condition

A7036 Chinstrap used with positive airway pressure device CPAP & Supplies

Treatment of WTC related respiratory condition

A7037 Tubing used with positive airway pressure device CPAP & Supplies

Treatment of WTC related respiratory condition

A7038

Filter, disposable, used with positive airway pressure device CPAP & Supplies

Treatment of WTC related respiratory condition

A7039

Filter, nondisposable, used with positive airway pressure device CPAP & Supplies

Treatment of WTC related respiratory condition

A7046

Water chamber for humidifier, used with positive airway pressure device, replacement, each CPAP & Supplies

Treatment of WTC related respiratory condition

A9279

Monitoring feature/device, stand-alone or integrated, any type, includes all y yp , accessories, components

Equipment, not otherwise q p , classified

Equipment, as prescribed by p y treating MD

E0135 Walker, folding (pickup), adjustable or fixed height

Medical Supplies/ Home Medical

Equipment, as prescribed by treating MD

E0163 Commode chair, mobile or stationary, with fixed arms

Medical Supplies/ Home Medical

Equipment, as prescribed by treating MD

E0245 Tub stool or bench Medical Supplies/ Home Medical

Equipment, as prescribed by treating MD

E0431 Portable gaseous oxygen system, rental Oxygen & Supplies

Treatment of WTC related respiratory condition

E0434

Portable liquid oxygen system, rental; includes portable container, supply reservoir… Oxygen & Supplies

Treatment of WTC related respiratory condition

E0470

Resp. assist devices, bi-level pressure capability, w/o backup rate feature, w/ noninvasive interface BiPAP & Supplies

Treatment of WTC related respiratory condition

E0471

Respiratory assist device, bi-level pressure capability, with back-up rate feature BiPAP & Supplies

Treatment of WTC related respiratory condition

E0562

Humidifier, heated, used with positive airway pressure device CPAP & Supplies

Treatment of WTC related respiratory condition

E0570 Nebulizer, with compressor Nebulizer & Supplies

Treatment of WTC related respiratory condition

E0571 Aerosol compressor Nebulizer & Supplies

Treatment of WTC related respiratory condition

E0575 Nebulizer, ultrasonic, large volume Nebulizer & Supplies

Treatment of WTC related respiratory condition

E0601 Continuous airway pressure (CPAP) device( ) CPAP & Suppliespp

Treatment of WTC related respiratory condition

E0935

Continuous passive motion exercise device for use on knee only

Adjunct to physical therapy (Range of Motion

Treatment of WTC related injury

E1390 Oxygen concentrator, single delivery port Oxygen & Supplies

Treatment of WTC related respiratory condition

E1392 Portable oxygen concentrator, rental Oxygen & Supplies

Treatment of WTC related respiratory condition

S9123

Nursing care, in the home;

by registered nurse, per hour (use for general nursing care only) Home Medical

Skilled nursing need; homebound

S9131 Physical therapy, in the home, per diem Home Medical

Skilled nursing need; homebound

DME List