| Short Descr | Primatrix | Coverage | Carrier Priced | Pricing Indicator(s) | 51 – Drugs | MPI | A – Not applicable, as HCPCS priced under one methodology | BETOS | O1E – Other drugs | TOS Code(s) | 1 – Medical care | Added Date | 1/1/2009 | 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 | Not applicable/unspecified. | MUE | Not applicable/unspecified. | OTS Orthotic | No | CCS Clinical Classification | 243 - DME and supplies |
| JC | Skin substitute used as a graft | KX | Requirements specified in the medical policy have been met | JZ | Zero drug amount discarded/not administered to any patient | GC | This service has been performed in part by a resident under the direction of a teaching physician | JW | Drug amount discarded/not administered to any patient |
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Date
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Action
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Notes
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|---|---|---|
| 2011-01-01 | Changed | Description Changed |
| 2009-01-01 | Added | - |