| Short Descr | Cocm by rhc/fqhc 60 min mo | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 13 – Physician Fee Schedule - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion) | MPI | A – Not applicable, as HCPCS priced under one methodology | Processing Note | SERVICES FOR RURAL HEALTH CLINIC OR FEDERALLY QUALIFIED HEALTH CENTER (RHC/FQHC) ONLY. | BETOS | M5D – Specialist - other | TOS Code(s) | 1 – Medical care | Added Date | 1/1/2018 | 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) | 0 - Physician Service Code | 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 | Service Paid under Fee Schedule or Payment System other than OPPS | MUE | 1 | MUE | Not applicable/unspecified. | OTS Orthotic | No |
| CG | Policy criteria applied |
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| 2018-01-01 | Added | Code Added. |
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