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Official Description

Injection, pegulicianine, 1 mg
Short Descr Inj, pegulicianine, 1 mg
Related Drugs LUMISIGHT
Coverage Special coverage instructions apply
Pricing Indicator(s) 53 – Statute
MPI A – Not applicable, as HCPCS priced under one methodology
Statute 1833(t)
BETOS O1E – Other drugs
TOS Code(s) 1 – Medical care
Added Date 10/1/2024
Action Code D – Discontinue procedure or modifier code (effective 1/1/2025)
Termination Date 12/31/2024
APC Status Indicator Pass-Through Drugs and Biologicals
MUE Not applicable/unspecified.
MUE Not applicable/unspecified.
OTS Orthotic No
Date
Action
Notes
2026-01-01 Deleted First appearance of deletion in codebook.
2025-01-01 Added First appearance in codebook.
2024-12-31 Deleted Code deleted.
2024-10-01 Added Code added.
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