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Official Description

Endoscope, single-use (i.e. disposable), upper gi, imaging/illumination device (insertable)
Short Descr Endoscope, single, ugi
Coverage Special coverage instructions apply
Pricing Indicator(s) 53 – Statute
MPI A – Not applicable, as HCPCS priced under one methodology
Statute 1833(t)
BETOS D1A – Medical/surgical supplies
TOS Code(s) 9 – Other medical items or services
Added Date 7/1/2020
APC Status Indicator Items and Services Packaged into APC Rates
ASC Payment Indicator Packaged service/item; no separate payment made.
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
SG Ambulatory surgical center (asc) facility service
Date
Action
Notes
2024-01-01 Note Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)
2020-07-01 Added Code added.
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