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Official Description

Technetium tc-99m pertechnetate, diagnostic, per millicurie
Short Descr Tc99m pertechnetate
Coverage Carrier Priced
Pricing Indicator(s) 57 – Other carrier priced
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS I1E – Standard imaging - nuclear medicine
TOS Code(s) 4 – Diagnostic radiology
Added Date 1/1/2003
Status Code Carriers Price the Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
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 30
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
JZ Zero drug amount discarded/not administered to any patient
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
GC This service has been performed in part by a resident under the direction of a teaching physician
GZ Item or service expected to be denied as not reasonable and necessary
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2003-01-01 Added Code added 1/1/2003
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