| Short Descr | Inj magnesium sulfate | Related Drugs | 50% MAGNESIUM SULFATE | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 51 – Drugs | MPI | A – Not applicable, as HCPCS priced under one methodology | MCM | 2049 | BETOS | O1E – Other drugs | TOS Code(s) | 1 – Medical care | Added Date | 1/1/1996 | Status Code | Excluded from Physician Fee Schedule by Regulation | 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | MUE | 20 | MUE | 0 | IOM | 100-02, 15, 50 | OTS Orthotic | No | CCS Clinical Classification | 240 - Medications (Injections, infusions and other forms) |
| JZ | Zero drug amount discarded/not administered to any patient | JW | Drug amount discarded/not administered to any patient | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GA | Waiver of liability statement issued as required by payer policy, individual case | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | KX | Requirements specified in the medical policy have been met | GX | Notice of liability issued, voluntary under payer policy | GZ | Item or service expected to be denied as not reasonable and necessary | JA | Administered intravenously | UD | Medicaid level of care 13, as defined by each state | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | 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. | GW | Service not related to the hospice patient's terminal condition | EJ | Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | JB | Administered subcutaneously | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | SA | Nurse practitioner rendering service in collaboration with a physician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GC | This service has been performed in part by a resident under the direction of a teaching physician | JK | One month supply or less of drug or biological | KP | First drug of a multiple drug unit dose formulation | KQ | Second or subsequent drug of a multiple drug unit dose formulation | N2 | Group 2 oxygen coverage criteria met | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | TB | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | TR | School-based individualized education program (iep) services provided outside the public school district responsible for the student |
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| 1996-01-01 | Added | Code added 1/1/1996 |