| Short Descr | Ablation, hifu, prostate | 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) | 55880 | BETOS | P6C – Minor procedures - other (Medicare fee schedule) | TOS Code(s) | 2 – Surgery | Added Date | 7/1/2017 | Termination Date | 12/31/2020 | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | MUE | Not applicable/unspecified. | MUE | Not applicable/unspecified. | OTS Orthotic | No |
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| 2020-12-31 | Deleted | Code deleted, see 55880 |
| 2017-07-01 | Added | Added |
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