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Try CasePilot| Short Descr | Insrt vent pm w/l vent lead | Coverage | Special coverage instructions apply | 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 | P2E – Major procedure, cardiovascular-Pacemaker insertion | TOS Code(s) | 2 – Surgery | Added Date | 1/1/2023 | APC Status Indicator | Non-Covered Service, not paid under OPPS | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | MUE | 1 | MUE | Not applicable/unspecified. | OTS Orthotic | No |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | KX | Requirements specified in the medical policy have been met |
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| 2025-01-01 | Note | Clerical change. Long description corrected retroactively to 1/1/2023. |
| 2023-01-01 | Added | Code added. |
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