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Official Description

Ambulance service, conventional air services, transport, one way (rotary wing)
Short Descr Rotary wing air transport
Coverage Carrier Priced
Pricing Indicator(s) 52 – Reasonable charge
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS O1A – Ambulance
TOS Code(s) D – Ambulance
Added Date 1/1/2001
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 Service Paid under Fee Schedule or Payment System other than OPPS
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 239 - Transportation - patient, provider, equipment
HH Integrated mental health/substance abuse program
SH Second concurrently administered infusion therapy
HI Integrated mental health and intellectual disability/developmental disabilities program
QN Ambulance service furnished directly by a provider of services
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
QL Patient pronounced dead after ambulance called
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.
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
ET Emergency services
GH Diagnostic mammogram converted from screening mammogram on same day
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
HD Pregnant/parenting women's program
HP Doctoral level
HS Family/couple without client present
RI Ramus intermedius coronary artery
SS Home infusion services provided in the infusion suite of the iv therapy provider
TN Rural/outside providers' customary service area
U1 Medicaid level of care 1, as defined by each state
U3 Medicaid level of care 3, as defined by each state
UJ Services provided at night
Date
Action
Notes
2001-01-01 Added Code added 1/1/2001
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Description
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Description
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