| Short Descr | Perc d-e cor revasc t cabg s | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 53 – Statute | MPI | A – Not applicable, as HCPCS priced under one methodology | Statute | 1833(t) | Processing Note | PAYMENT IS FOR HOSPITAL OUTPATIENT ONLY. NOT PAYABLE UNDER THE PHYSICIAN FEE SCHEDULE; IN ACCORDANCE WITH FR DATE 8/9/2002 (HOPPS), PAGE 52105. | BETOS | P2F – Major procedure, cardiovascular-Other | TOS Code(s) | 2 – Surgery | Added Date | 1/1/2013 | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | MUE | 2 | MUE | Not applicable/unspecified. | OTS Orthotic | No | CCS Clinical Classification | 45 - Percutaneous transluminal coronary angioplasty (PTCA) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | RC | Right coronary artery |
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| 2013-01-01 | Added | Added, replaced G0290 |
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