zimmer surgical products to hcpcs code crosswalk · product # edi item # item description header 1...

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© 2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 1 Surgical Products NOTE #1: For Medicare Outpatient Hospital procedures, C1776 [Joint device (implantable)] and C1713 [Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)] might be allowable for purposes of billing for Zimmer implantable devices and products. Please check with your Payer(s) for complete billing and reimbursement details. NOTE #2: For implantable devices and products in the Zimmer Catalog, there are no separately reportable HCPCS codes for billing Inpatient Hospital Medicare procedures on the UB-04 Claim Form. These implantable devices and products are considered integral to the procedure performed, and the Medicare MS-DRG payment includes their costs in the total facility payment. Revenue Code(s) in the 027X range could be appended on the UB-04 claim form to track facility charges for such implantable devices and products. Please check with your Payer(s) for complete billing and reimbursement details. Product # EDI Item # Item Description Header 1 Header 2 Product Type Description Product Subsystem Description 2011 HCPCS Code (If Applicable) 2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective Payment System 2011 Long HCPCS Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3 60-3000-101-00 60300010100 ATS 3000 TOURNIQUET W/HOSES AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-3000-102-00 60300010200 ATS 3000 TOURNIQUET W/HOSES & CUFFS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-3000-103-00 60300010300 ATS 3000 TOURNIQUET W/HOSES, CUFFS, STD, BSKT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-3000-104-00 60300010400 ATS 3000 TOURNIQUET W/HOSES, STAND, BASKET AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 62-2100-096-00 62210009600 MANUAL, ATS3000 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-1200-101-00 60120010100 ATS1200 TOURNIQUET W/HOSES AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-1200-102-00 60120010200 ATS1200 TOURNIQUET W/HOSES & CUFFS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-1200-103-00 60120010300 ATS 1200 TOURNIQUET W/HOSES, CUFFS, STD, BSKT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-1200-104-00 60120010400 ATS 1200 TOURNIQUET W/HOSES, STAND, BASKET AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 62-8000-015-00 62800001500 MANUAL, ATS1200 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-0750-101-00 60075010100 ATS 750 TOURNIQUET W/HOSE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 750 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-0750-102-00 60075010200 ATS 750 TOURNIQUET W/HOSE & CUFFS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 750 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-0750-103-00 60075010300 ATS 750 TOURNIQUET W/HOSE, CUFFS, STD, BSKT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 750 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-0750-104-00 60075010400 ATS 750 TOURNIQUET W/HOSE, STAND, BASKET AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 750 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-2000-110-00 60200011000 ATS 2000 CALIBRATION KIT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 2000 TOURNIQUET SYSTEM ACCESSORIES Tourniquets Tourniquets (Extremity) N/A N/A N/A 62-2000-101-00 62200010100 ATS 2000 MANUAL W/CUFF ALERT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 2000 TOURNIQUET SYSTEM ACCESSORIES Tourniquets Tourniquets (Extremity) N/A N/A N/A 60-7070-053-00 60707005300 18 DPSB STER DISP CUFF LUER LOCK W/SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non- Sterile Supplies 0271, Sterile Supplies 0272 Charges reported with UB-04 revenue codes 0270,0271 and 0272 on Medicare outpatient claims are considered packaged services. Under Medicare OPPS, packaged services are not separately payable. See Pub 100-04 Medicare Claims Processing Manual. 60-7070-056-00 60707005600 34 DPSB STER DISP CUFF LUER LOCK W/SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non- Sterile Supplies 0271, Sterile Supplies 0272 Charges reported with UB-04 revenue codes 0270,0271 and 0272 on Medicare outpatient claims are considered packaged services. Under Medicare OPPS, packaged services are not separately payable. See Pub 100-04 Medicare Claims Processing Manual. 60-7070-152-00 60707015200 12 DPSB STER DISP CUFF PLC W/SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non- Sterile Supplies 0271, Sterile Supplies 0272 Charges reported with UB-04 revenue codes 0270,0271 and 0272 on Medicare outpatient claims are considered packaged services. Under Medicare OPPS, packaged services are not separately payable. See Pub 100-04 Medicare Claims Processing Manual. 60-7070-153-00 60707015300 18 DPSB STER DISP CUFF PLC W/SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non- Sterile Supplies 0271, Sterile Supplies 0272 Charges reported with UB-04 revenue codes 0270,0271 and 0272 on Medicare outpatient claims are considered packaged services. Under Medicare OPPS, packaged services are not separately payable. See Pub 100-04 Medicare Claims Processing Manual. 60-7070-154-00 60707015400 24 DPSB STER DISP CUFF PLC W/SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non- Sterile Supplies 0271, Sterile Supplies 0272 Charges reported with UB-04 revenue codes 0270,0271 and 0272 on Medicare outpatient claims are considered packaged services. Under Medicare OPPS, packaged services are not separately payable. See Pub 100-04 Medicare Claims Processing Manual. 60-7070-155-00 60707015500 30 DPSB STER DISP CUFF PLC W/SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non- Sterile Supplies 0271, Sterile Supplies 0272 Charges reported with UB-04 revenue codes 0270,0271 and 0272 on Medicare outpatient claims are considered packaged services. Under Medicare OPPS, packaged services are not separately payable. See Pub 100-04 Medicare Claims Processing Manual. 60-7070-156-00 60707015600 34 DPSB STER DISP CUFF PLC W/SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non- Sterile Supplies 0271, Sterile Supplies 0272 Charges reported with UB-04 revenue codes 0270,0271 and 0272 on Medicare outpatient claims are considered packaged services. Under Medicare OPPS, packaged services are not separately payable. See Pub 100-04 Medicare Claims Processing Manual. 60-7070-157-00 60707015700 42 DPSB STER DISP CUFF PLC W/SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non- Sterile Supplies 0271, Sterile Supplies 0272 Charges reported with UB-04 revenue codes 0270,0271 and 0272 on Medicare outpatient claims are considered packaged services. Under Medicare OPPS, packaged services are not separately payable. See Pub 100-04 Medicare Claims Processing Manual.

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  • 2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 1

    Surgical ProductsNOTE #1: For Medicare Outpatient Hospital procedures, C1776 [Joint device (implantable)] and C1713 [Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)] might be allowable for purposes of billing for Zimmer implantable devices and products. Please check with your Payer(s) for complete billing and reimbursement details.

    NOTE #2: For implantable devices and products in the Zimmer Catalog, there are no separately reportable HCPCS codes for billing Inpatient Hospital Medicare procedures on the UB-04 Claim Form. These implantable devices and products are considered integral to the procedure performed, and the Medicare MS-DRG payment includes their costs in the total facility payment. Revenue Code(s) in the 027X range could be appended on the UB-04 claim form to track facility charges for such implantable devices and products. Please check with your Payer(s) for complete billing and reimbursement details.

    Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    60-3000-101-00 60300010100 ATS 3000 TOURNIQUET W/HOSES AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-3000-102-00 60300010200 ATS 3000 TOURNIQUET W/HOSES &

    CUFFS

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-3000-103-00 60300010300 ATS 3000 TOURNIQUET W/HOSES,

    CUFFS, STD, BSKT

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-3000-104-00 60300010400 ATS 3000 TOURNIQUET W/HOSES,

    STAND, BASKET

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-2100-096-00 62210009600 MANUAL, ATS3000 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 3000 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-1200-101-00 60120010100 ATS1200 TOURNIQUET W/HOSES AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-1200-102-00 60120010200 ATS1200 TOURNIQUET W/HOSES &

    CUFFS

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-1200-103-00 60120010300 ATS 1200 TOURNIQUET W/HOSES,

    CUFFS, STD, BSKT

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-1200-104-00 60120010400 ATS 1200 TOURNIQUET W/HOSES,

    STAND, BASKET

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-8000-015-00 62800001500 MANUAL, ATS1200 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 1200 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-101-00 60075010100 ATS 750 TOURNIQUET W/HOSE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 750 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-102-00 60075010200 ATS 750 TOURNIQUET W/HOSE &

    CUFFS

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 750 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-103-00 60075010300 ATS 750 TOURNIQUET W/HOSE,

    CUFFS, STD, BSKT

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 750 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-104-00 60075010400 ATS 750 TOURNIQUET W/HOSE,

    STAND, BASKET

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 750 TOURNIQUET SYSTEM MACHINES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-2000-110-00 60200011000 ATS 2000 CALIBRATION KIT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 2000 TOURNIQUET SYSTEM

    ACCESSORIES

    Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-2000-101-00 62200010100 ATS 2000 MANUAL W/CUFF ALERT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. 2000 TOURNIQUET SYSTEM

    ACCESSORIES

    Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-7070-053-00 60707005300 18 DPSB STER DISP CUFF LUER

    LOCK W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-056-00 60707005600 34 DPSB STER DISP CUFF LUER

    LOCK W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-152-00 60707015200 12 DPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-153-00 60707015300 18 DPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-154-00 60707015400 24 DPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-155-00 60707015500 30 DPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-156-00 60707015600 34 DPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-157-00 60707015700 42 DPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 2

    60-7075-052-00 60707505200 12 SPSB STER DISP CUFF LUER

    LOCK W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-053-00 60707505300 18 SPSB STER DISP CUFF LUER

    LOCK W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-054-00 60707505400 24 SPSB STER DISP CUFF LUER

    LOCK W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-055-00 60707505500 30 SPSB STER DISP CUFF LUER

    LOCK W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-056-00 60707505600 34 SPSB STER DISP CUFF LUER

    LOCK W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-152-00 60707515200 12 SPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-153-00 60707515300 18 SPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-154-00 60707515400 24 SPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-155-00 60707515500 30 SPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-156-00 60707515600 34 SPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-157-00 60707515700 42 SPSB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7080-152-00 60708015200 18 DPDB STER DISP CUFF PLC

    W/SLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7080-153-00 60708015300 24 DPDB STER DISP CUFF PLC

    WSLEEVE

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS W/SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 3

    60-7070-001-00 60707000100 8 DPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-002-00 60707000200 12 DPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-003-00 60707000300 18 DPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-004-00 60707000400 24 DPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-005-00 60707000500 30 DPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-006-00 60707000600 34 DPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-007-00 60707000700 42 DPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-101-00 60707010100 8 DPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-102-00 60707010200 12 DPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-103-00 60707010300 18 DPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-104-00 60707010400 24 DPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-105-00 60707010500 30 DPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7070-106-00 60707010600 34 DPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 4

    60-7070-107-00 60707010700 42 DPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-001-00 60707500100 8 SPSB STER DISP CUFF LUER LOCK AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-002-00 60707500200 12 SPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-003-00 60707500300 18 SPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-004-00 60707500400 24 SPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-005-00 60707500500 30 SPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-006-00 60707500600 34 SPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-007-00 60707500700 42 SPSB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-101-00 60707510100 8 SPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-102-00 60707510200 12 SPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-103-00 60707510300 18 SPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-104-00 60707510400 24 SPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-105-00 60707510500 30 SPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 5

    60-7075-106-00 60707510600 34 SPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7075-107-00 60707510700 42 SPSB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7080-001-00 60708000100 12 DPDB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7080-002-00 60708000200 18 DPDB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7080-003-00 60708000300 24 DPDB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7080-101-00 60708010100 12 DPDB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7080-102-00 60708010200 18 DPDB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7080-103-00 60708010300 24 DPDB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7085-001-00 60708500100 12 SPDB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7085-002-00 60708500200 18 SPDB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7085-003-00 60708500300 24 SPDB STER DISP CUFF LUER

    LOCK

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7085-101-00 60708510100 12 SPDB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7085-102-00 60708510200 18 SPDB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 6

    60-7085-103-00 60708510300 24 SPDB STER DISP CUFF PLC AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) STERILE DISPOSABLE CUFFS Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7500-001-00 60750000100 8 DPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7500-002-00 60750000200 12 DPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7500-003-00 60750000300 18 DPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7500-004-00 60750000400 24 DPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7500-005-00 60750000500 30 DPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7500-006-00 60750000600 34 DPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7500-007-00 60750000700 42 DPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7555-001-00 60755500100 12 DPDB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7555-002-00 60755500200 18 DPDB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7555-003-00 60755500300 24 DPDB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7600-001-00 60760000100 8 SPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7600-002-00 60760000200 12 SPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 7

    60-7600-003-00 60760000300 18 SPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7600-004-00 60760000400 24 SPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7600-005-00 60760000500 30 SPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7600-006-00 60760000600 34 SPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7600-007-00 60760000700 42 SPSB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7666-001-00 60766600100 12 SPDB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7666-002-00 60766600200 18 SPDB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7666-003-00 60766600300 24 SPDB ATS CYLINDRICAL CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) REUSABLE CYLINDRICAL CUFFS (NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7350-002-00 60735000200 SPSB CONTOUR UPPER LIMB CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFFS W/SLEEVES (REUSABLE,

    NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7350-003-00 60735000300 SPSB CONTOUR THIGH CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFFS W/SLEEVES (REUSABLE,

    NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7350-004-00 60735000400 SPSB CONTOUR LOWER LEG CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFFS W/SLEEVES (REUSABLE,

    NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7350-011-00 60735001100 SPDB CONTOUR UPPPER LIMB IVRA

    CUFF

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFFS W/SLEEVES (REUSABLE,

    NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7450-002-00 60745000200 DPSB CONTOUR UPPER LIMB CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFFS W/SLEEVES (REUSABLE,

    NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 8

    60-7450-003-00 60745000300 DPSB CONTOUR THIGH CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFFS W/SLEEVES (REUSABLE,

    NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7450-004-00 60745000400 DPSB CONTOUR LOWER LEG CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFFS W/SLEEVES (REUSABLE,

    NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7450-011-00 60745001100 DPDB CONTOUR UPPER LIMB IVRA

    CUFF

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFFS W/SLEEVES (REUSABLE,

    NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7500-008-00 60750000800 DPSB CONTOUR CUFF - XL (30 IN-39

    IN)

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) XL CONTOUR CUFFS (REUSABLE, NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7600-008-00 60760000800 SPSB CONTOUR CUFF - XL (30 IN-39

    IN)

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) XL CONTOUR CUFFS (REUSABLE, NON-

    STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7920-001-00 60792000100 PROT.SLEEVE/CONT.ARM CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFF SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7920-002-00 60792000200 PROT.SLEEVE/CONT.THIGHCUF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFF SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7920-003-00 60792000300 PROT.SLEEVE/CONT.LEG CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CONTOUR CUFF SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-001-00 60800000100 SPSB EXTRA SMALL ADULT CUFF 3

    IN

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) SMALL ADULT CUFFS W/SLEEVES

    (REUSABLE, NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-002-00 60800000200 SPSB SMALL ADULT CUFF 3.5 IN AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) SMALL ADULT CUFFS W/SLEEVES

    (REUSABLE, NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8100-001-00 60810000100 DPSB EXTRA SMALL ADULT CUFF 3

    IN

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) SMALL ADULT CUFFS W/SLEEVES

    (REUSABLE, NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8100-002-00 60810000200 DPSB SMALL ADULT CUFF 3.5 IN AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) SMALL ADULT CUFFS W/SLEEVES

    (REUSABLE, NON-STERILE)

    Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-7910-001-00 60791000100 PROT. SLEEVE/ X-SM ADULT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) SMALL ADULT SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 9

    60-7910-002-00 60791000200 PROT. SLEEVE/ SM ADULT 10 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) SMALL ADULT SLEEVES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-008-00 60800000800 8 INCH CUFF SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF SLEEVES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-012-00 60800001200 12 INCH CUFF SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF SLEEVES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-018-00 60800001800 18 INCH CUFF SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF SLEEVES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-024-00 60800002400 24 INCH CUFF SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF SLEEVES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-030-00 60800003000 30 INCH CUFF SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF SLEEVES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-034-00 60800003400 34 INCH CUFF SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF SLEEVES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-8000-042-00 60800004200 42 INCH CUFF SLEEVE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF SLEEVES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-001-00 60269400100 ESMARK BANDAGES, DISP, 3IN X 9FT

    STER

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-002-00 60269400200 ESMARK BANDAGES, DISP 4INX 9FT

    STER

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-003-00 60269400300 ESMARK BANDAGES, DISP, 6IN X 9FT

    STER

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-004-00 60269400400 ESMARK BANDAGES, DISP, 3IN X

    12FT STER

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-005-00 60269400500 ESMARK BANDAGES, DISP, 4IN X

    12FT STER

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 10

    60-2694-006-00 60269400600 ESMARK BANDAGES, DISP, 6IN X

    12FT STER

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-011-00 60269401100 LATEX FREE ESMARK 3IN. X 9FT. AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-012-00 60269401200 LATEX FREE ESMARK 4IN. X 9FT. AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-013-00 60269401300 LATEX FREE ESMARK 5.5IN X 9FT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-014-00 60269401400 LATEX FREE ESMARK 3IN. X 12FT. AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-015-00 60269401500 LATEX FREE ESMARK 4IN. X 12FT. AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2694-016-00 60269401600 LATEX FREE ESMARK 5.5IN X 12FT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) ESMARK BANDAGES - STERILE Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-1812-001-00 60181200100 DUAL STERILE EXTENSION HOSE

    W/LUER LOCK CONNECTOR

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-1812-101-00 60181210100 DUAL STERILE EXTENSION HOSE

    W/PLC CONNECTOR

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-2790-001-00 60279000100 ATS 500/750/1200 HOSE, RED/WE AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-2790-002-00 60279000200 ATS 500/750/1200 HOSE, BLUE/W AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-4009-001-00 60400900100 SINGLE STERILE EXTENSION HOSE

    W/LUER LOCK CONNECTR

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-4009-101-00 60400910100 SINGLE STERILE EXTENSION HOSE

    W/PLC CONNECTOR

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A General Medical Surgical Supplies 0270, Non-

    Sterile Supplies 0271, Sterile Supplies 0272

    Charges reported with UB-04 revenue codes 0270,0271 and

    0272 on Medicare outpatient claims are considered packaged

    services. Under Medicare OPPS, packaged services are not

    separately payable.

    See Pub 100-04 Medicare

    Claims Processing Manual.

    60-4017-001-00 60401700100 ATS 1500/2000 DUAL HOSE, BLU/W AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-4018-001-00 60401800100 ATS 1500/2000 DUAL HOSE, RED/W AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-7300-105-00 60730010500 CPC-TO-LUER ADAPTORS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-7500-100-00 60750010000 A.T.S. DUAL HOSE RETROFIT KIT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-7600-100-00 60760010000 A.T.S. 500 HOSE RETROFIT KIT AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-7600-300-00 60760030000 RED UNIVERSAL HOSE ADAPTERS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-7600-400-00 60760040000 BLUE UNIVERSAL HOSE ADAPTERS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    61-7308-000-00 61730800000 O-RINGS FOR TOURNIQUET CUFF AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) CUFF HOSES Tourniquets Tourniquets (Extremity) N/A N/A N/A

    06-0015-012-63 06001501263 CALIBRATION HOSE ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    06-0020-013-70 06002001370 PLUMBING ASSY ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-01 60075000001 CONTROL BOARD ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-02 60075000002 BATTERY ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-03 60075000003 MEMBRANE CONTROL PANEL ATS

    750

    AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

  • Product # EDI Item # Item Description Header 1 Header 2Product Type Description

    Product Subsystem Description

    2011 HCPCS Code (If Applicable)

    2011 HCPCS Code Status Indicator for Medicare Outpatient Prospective

    Payment System2011 Long HCPCS

    Descriptior Common UB-04 Revenue Codes Comment 1 Comment 2 Comment 3

    2011 Zimmer Surgical, Inc. | This document may not be reproduced, distributed, transmitted, displayed, published or broadcast in whole or in part without prior written permission. PAGE 11

    60-0750-000-04 60075000004 12 VOLT PUMP ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-05 60075000005 CASE BASE ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-06 60075000006 CASE LID ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-07 60075000007 ROTARY KNOB ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-08 60075000008 BATTERY BRACKET ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-09 60075000009 DEFLATE VALVE ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-10 60075000010 POWER ENTRY MODULE ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-11 60075000011 MAIN WIRE HARNESS ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-12 60075000012 BATTERY HARNESS ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-13 60075000013 OVERPRESSURE SWITCH HARNESS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-0750-000-14 60075000014 OVERPRESSURE SWITCH ATS 750 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-2000-000-03 60200000003 PUMP W/O TUBING ATS2000 AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-2000-000-06 60200000006 VALVE 24VOLT CLIPPARD SLOW AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-2000-000-07 60200000007 VALVE 24VOLT BURKERT:FAST AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    60-2000-000-08 60200000008 FUSE 1A 5X20MM AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-1131-001-00 62113100100 ALARM SILENCE SWITCH W/O LAMP AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-1132-001-00 62113200100 ALARM SILENCE LAMP AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-1133-001-00 62113300100 ALARM SILENCE LENS RED AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-1134-001-00 62113400100 FEET W/O SCREWS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-1137-001-00 62113700100 FUSE DRAWER 1/4IN X 1 1/4IN AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-1138-001-00 62113800100 FUSE DRAWER 5X20 CM AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-1168-001-00 62116800100 ALARM SILENCE HARNESS AUTOMATIC TOURNIQUET SYSTEMS (A.T.S.) A.T.S. PARTS Tourniquets Tourniquets (Extremity) N/A N/A N/A

    62-1169-001-00 62116900100 SPEAKER HARNESS AUTOMA