| Short Descr | Abd us w/contrast | 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) | 76978 | BETOS | I3B – Echography/ultrasonography - abdomen/pelvis | TOS Code(s) | 4 – Diagnostic radiology | Added Date | 10/1/2016 | Termination Date | 12/31/2018 | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | MUE | Not applicable/unspecified. | MUE | Not applicable/unspecified. | OTS Orthotic | No |
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