| Short Descr | Factor viii (eloctate) | Related Drugs | ELOCTATE | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 53 – Statute | MPI | A – Not applicable, as HCPCS priced under one methodology | Statute | 1833(t) | Cross-Reference(s) | Q9975 | BETOS | O1E – Other drugs | TOS Code(s) | 9 – Other medical items or services | Added Date | 1/1/2015 | Termination Date | 3/31/2015 | MUE | Not applicable/unspecified. | MUE | Not applicable/unspecified. | OTS Orthotic | No |
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Date
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Action
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Notes
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|---|---|---|
| 2015-04-01 | Deleted | Deleted |
| 2015-03-31 | Deleted | Code deleted, see Q9975 |
| 2015-01-01 | Added | Added |