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L7404 - Add ue prost a/e acrylic

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Field Value
HCPCS Code: L7404
Long Description: Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material
Short Description: Add ue prost a/e acrylic
Pricing Indicator 1: 38 (Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings))
Multiple Pricing Code: A (Not applicable as HCPCS priced under one methodology)
Statute Number:
Coverage Code: C (Carrier judgment)
ASC Payment Group Code:
Processing Note Number:
Berenson-Eggers Type of Service (BETOS) Code: D1F (Orthotic devices)
Type of Service Code 1: P (Lump sum purchase of DME, prosthetics, orthotics)
Anesthesia Base Unit Quality: 0
Code Added: 01-01-2006
Action Effective Date: 01-01-2006
Action Code: N (No maintenance for this code)