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Official Description

Bls specialized service disposable supplies; defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances)
Short Descr Bls defibrillation supplies
Coverage Not payable by Medicare
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')
BETOS O1A – Ambulance
TOS Code(s) D – Ambulance
Added Date 1/1/1995
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 Non-Covered Service, not paid under OPPS
MUE 0
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 239 - Transportation - patient, provider, equipment
SH Second concurrently administered infusion therapy
EE Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
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
HH Integrated mental health/substance abuse program
QL Patient pronounced dead after ambulance called
RR Rental (use the 'rr' modifier when dme is to be rented)
Date
Action
Notes
1995-01-01 Added Code added 1/1/1995
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