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Official Description

Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment
Short Descr Linear acc based stero radio
Coverage Special coverage instructions apply
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
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 I1F – Standard imaging - other
TOS Code(s) 4 – Diagnostic radiology
Added Date 4/1/2002
Termination Date 12/31/2014
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
MUE Not applicable/unspecified.
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 211 - Therapeutic radiology
Date
Action
Notes
2015-01-01 Deleted Deleted
2002-04-01 Added Code added 4/1/2002
Code
Description
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