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Official Description

Omegaven, 10 grams lipids
Short Descr Omegaven, 10 grams lipids
Coverage Special coverage instructions apply
Pricing Indicator(s) 39 – Supplies And Surgical Dressings - Parenteral and Enteral Nutrition
MPI A – Not applicable, as HCPCS priced under one methodology
Processing Note NCD MANUAL 180.2.
BETOS O1C – Enteral and parenteral
TOS Code(s) E – Enteral/parenteral nutrients/supplies
Added Date 1/1/2020
APC Status Indicator Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
MUE 0
MUE 15
OTS Orthotic No
KX Requirements specified in the medical policy have been met
GX Notice of liability issued, voluntary under payer policy
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
GA Waiver of liability statement issued as required by payer policy, individual case
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
Date
Action
Notes
2020-01-01 Added Code added.
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