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Official Description

Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg
Short Descr Instill, bupivac and meloxic
Related Drugs ZYNRELEF
Coverage Special coverage instructions apply
Pricing Indicator(s) 53 – Statute
MPI A – Not applicable, as HCPCS priced under one methodology
Statute 1833(t)
ASC Payment Group Code YY – 1/01/2022
BETOS O1E – Other drugs
TOS Code(s) 9 – Other medical items or services
Added Date 1/1/2022
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 400
MUE Not applicable/unspecified.
OTS Orthotic No
JZ Zero drug amount discarded/not administered to any patient
SG Ambulatory surgical center (asc) facility service
JW Drug amount discarded/not administered to any patient
RT Right side (used to identify procedures performed on the right side of the body)
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.
LT Left side (used to identify procedures performed on the left side of the body)
GA Waiver of liability statement issued as required by payer policy, individual case
Date
Action
Notes
2022-01-01 Added Code added.
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Description
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