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Try CasePilot| Short Descr | Open exc cerv node(s) w/ id | Coverage | Carrier Priced | Pricing Indicator(s) | 11 – Physician Fee Schedule - Price established using national RVUs | MPI | A – Not applicable, as HCPCS priced under one methodology | ASC Payment Group Code | YY – 1/01/2023 | Processing Note | THESE CODES ARE USED ONLY UNDER THE ASC PAYMENT SYSTEM. REFER TO THE 2023 OPPS/ASC FINAL RULE AND THE DISCUSSION ON THE ASC SPECIAL PAYMENT POLICY FOR OPPS COMPLEXITY-ADJUSTED C-APCs FOR MORE INFORMATION. | BETOS | P5E – Ambulatory procedures - other | TOS Code(s) | 2 – Surgery | Added Date | 1/1/2023 | APC Status Indicator | Non-Covered Service, not paid under OPPS | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | MUE | 1 | MUE | Not applicable/unspecified. | OTS Orthotic | No |
| 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. | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2025-01-01 | Note | Clerical change. |
| 2023-01-01 | Added | Code added. |
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