Tip: Some of the information displayed on this page is read-only and cannot be changed.Use this page to enter an Assistive Tech line item for a claim.
Tip: Some of the information displayed on this page is read-only and cannot be changed.
The following information on this page is read-only and cannot be changed:
AT Line displays the application-generated line item number for the Assistive Tech line.
Unit Conversion displays the current unit conversion where 1 unit equals 1 item.
Complete the following information to enter an Assistive Tech line for the claim:
In Purchase Date, enter the date on which the line was purchased. This is required information.
In HCPCS Code, enter the HCPCS code for the service line. This is required information.
In Units, enter the total number of units charged for the service line. You can enter up to 4 numeric digits in this text box. 1 unit equals 1 item. This is required information.
In Total Charges $, enter the total dollar amount charged for the service. You can enter up to 9 numeric digits in this text box. This is required information.
Click the following button(s) as necessary:
Click Reset to clear any unsaved changes and restore the previously displayed information.
Click Close to return to the previous page.
Click Add to Claim to save any information that was entered on this page.
Click the following link(s) to see how to complete a task step-by-step: