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Official Description

Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie
Short Descr Gallium illuccix 1 millicure
Related Drugs ILLUCCIX
Coverage Carrier Priced
Pricing Indicator(s) 57 – Other carrier priced
MPI A – Not applicable, as HCPCS priced under one methodology
ASC Payment Group Code YY – 7/01/2022
BETOS I1E – Standard imaging - nuclear medicine
TOS Code(s) 4 – Diagnostic radiology
Added Date 7/1/2022
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 Pass-Through Drugs and Biologicals
ASC Payment Indicator Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate.
MUE 7
MUE Not applicable/unspecified.
OTS Orthotic No
JZ Zero drug amount discarded/not administered to any patient
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
JW Drug amount discarded/not administered to any patient
KX Requirements specified in the medical policy have been met
GW Service not related to the hospice patient's terminal condition
ME The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
MG The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
TB Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
Date
Action
Notes
2023-01-01 Added First appearance in codebook.
2022-07-01 Added Code added.
Code
Description
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