| Short Descr | Sterile gauze > 48 sq in | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 35 – Supplies And Surgical Dressings - Surgical dressings (price subject to floors and ceilings) | MPI | A – Not applicable, as HCPCS priced under one methodology | MCM | 2079 | BETOS | D1A – Medical/surgical supplies | TOS Code(s) | S – Surgical dressings or other medical supplies | Added Date | 1/1/1997 | Status Code | Bundled/Excluded Code | 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 | Items and Services Packaged into APC Rates | MUE | 0 | MUE | Not applicable/unspecified. | IOM | 100-02, 15, 100 | OTS Orthotic | No | CCS Clinical Classification | 243 - DME and supplies |
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Date
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Action
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Notes
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| 1997-01-01 | Added | Code added 1/1/1997 |