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Try CasePilot| Short Descr | Extra ambulance attendant | 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 |
| 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 | HR | Family/couple with client present | HH | Integrated mental health/substance abuse program | HN | Bachelors degree level | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | RP | Replacement and repair -rp may be used to indicate replacement of dme, orthotic and prosthetic devices which have been in use for sometime. the claim shows the code for the part, followed by the 'rp' modifier and the charge for the part. | SH | Second concurrently administered infusion therapy | NR | New when rented (use the 'nr' modifier when dme which was new at the time of rental is subsequently purchased) | QN | Ambulance service furnished directly by a provider of services | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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 | GA | Waiver of liability statement issued as required by payer policy, individual case | GM | Multiple patients on one ambulance trip | GW | Service not related to the hospice patient's terminal condition | HD | Pregnant/parenting women's program | HE | Mental health program | HI | Integrated mental health and intellectual disability/developmental disabilities program | HP | Doctoral level | QL | Patient pronounced dead after ambulance called | RD | Drug provided to beneficiary, but not administered "incident-to" | RR | Rental (use the 'rr' modifier when dme is to be rented) | SS | Home infusion services provided in the infusion suite of the iv therapy provider | TU | Special payment rate, overtime |
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| 1995-01-01 | Added | Code added 1/1/1995 |
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