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Official Description

Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie
Short Descr Gallium locametz 1 millicuri
Related Drugs LOCAMETZ
Coverage Carrier Priced
Pricing Indicator(s) 57 – Other carrier priced
MPI A – Not applicable, as HCPCS priced under one methodology
ASC Payment Group Code YY – 10/01/2022
BETOS I1E – Standard imaging - nuclear medicine
TOS Code(s) 4 – Diagnostic radiology
Added Date 10/1/2022
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 Pass-Through Drugs and Biologicals
ASC Payment Indicator Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
MUE 7
MUE Not applicable/unspecified.
OTS Orthotic No
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
JZ Zero drug amount discarded/not administered to any patient
GA Waiver of liability statement issued as required by payer policy, individual case
JW Drug amount discarded/not administered to any patient
KX Requirements specified in the medical policy have been met
Date
Action
Notes
2023-01-01 Added First appearance in codebook.
2022-10-01 Added Code added.
Code
Description