| Short Descr | Mra, w/dye, upper extremity | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 53 – Statute | MPI | A – Not applicable, as HCPCS priced under one methodology | Statute | 1833(t) | ASC Payment Group Code | YY – 10/01/2010 | BETOS | I2D – Advanced imaging - MRI/MRA: other | TOS Code(s) | 4 – Diagnostic radiology | Added Date | 10/1/2010 | APC Status Indicator | Codes That May Be Paid Through a Composite APC | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. | MUE | 2 | MUE | Not applicable/unspecified. | OTS Orthotic | No | CCS Clinical Classification | 198 - Magnetic resonance imaging |
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| 2010-10-01 | Added | Code added 10/1/2010 |
| 2010-06-03 | Added | Effective. |
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