| HCPCS Code: |
A4617 |
| Long Description: |
Mouth piece |
| Short Description: |
Mouth piece |
| Pricing Indicator 1: |
00 (Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)) |
| Multiple Pricing Code: |
9 (Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is 99)) |
| Coverage Issues Manual 1: |
60-4 |
| MCM Reference Section Number 1: |
3312 |
| Statute Number: |
|
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
D1C (Oxygen and supplies) |
| Type of Service Code 1: |
P (Lump sum purchase of DME, prosthetics, orthotics) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-1990 |
| Action Effective Date: |
01-01-2009 |
| Action Code: |
N (No maintenance for this code) |
