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Official Description

Betadine or phisohex solution, per pint
Short Descr Betadine/phisohex solution
Coverage Carrier Priced
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 D1A – Medical/surgical supplies
TOS Code(s) L – ESRD supplies
Added Date 1/1/1985
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 Items and Services Packaged into APC Rates
MUE 0
MUE 0
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
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
A1 Dressing for one wound
KX Requirements specified in the medical policy have been met
GW Service not related to the hospice patient's terminal condition
A2 Dressing for two wounds
AY Item or service furnished to an esrd patient that is not for the treatment of esrd
EY No physician or other licensed health care provider order for this item or service
GZ Item or service expected to be denied as not reasonable and necessary
Date
Action
Notes
1985-01-01 Added Code added 1/1/1985
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