| Short Descr | Fixed wing air transport | Coverage | Carrier Priced | Pricing Indicator(s) | 52 – Reasonable charge | MPI | A – Not applicable, as HCPCS priced under one methodology | BETOS | O1A – Ambulance | TOS Code(s) | D – Ambulance | Added Date | 1/1/2001 | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | MUE | 1 | MUE | Not applicable/unspecified. | OTS Orthotic | No | CCS Clinical Classification | 239 - Transportation - patient, provider, equipment |
| GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | HH | Integrated mental health/substance abuse program | QN | Ambulance service furnished directly by a provider of services | GZ | Item or service expected to be denied as not reasonable and necessary | GX | Notice of liability issued, voluntary under payer policy | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | ET | Emergency services | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | HI | Integrated mental health and intellectual disability/developmental disabilities program | HS | Family/couple without client present | LL | Lease/rental (use the 'll' modifier when dme equipment rental is to be applied against the purchase price) | PI | Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing | QL | Patient pronounced dead after ambulance called | RI | Ramus intermedius coronary artery | SH | Second concurrently administered infusion therapy | TN | Rural/outside providers' customary service area |
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| 2001-01-01 | Added | Code added 1/1/2001 |