Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.
Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator.
Lower extremity prosthesis functional level 2 - has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. typical of the limited community ambulator.
Lower extremity prosthesis functional level 3 - has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
Lower extremity prosthesis functional level 4 - has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete.
Add on option/accessory for wheelchair
Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim
Replacement of special power wheelchair interface
Drug or biological infused through dme
Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
Item designated by fda as class iii device
Dmepos item subject to dmepos competitive bidding program number 1
Dmepos item, initial claim, purchase or first month rental
Dmepos item, second or third month rental
Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
Dmepos item subject to dmepos competitive bidding program number 2
Dmepos item delivered via mail
Replacement of facial prosthesis including new impression/moulage
Replacement of facial prosthesis using previous master model
Single drug unit dose formulation