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Official Description

Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program
Short Descr Cdsm medicalis
Coverage Carrier Priced
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
BETOS Z2 – Undefined codes
TOS Code(s) 1 – Medical care
Added Date 1/1/2020
Action Code D – Discontinue procedure or modifier code (effective 1/1/2025)
Termination Date 12/31/2024
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Non-Covered Service, not paid under OPPS
MUE Not applicable/unspecified.
MUE Not applicable/unspecified.
OTS Orthotic No
GC This service has been performed in part by a resident under the direction of a teaching physician
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
MG The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Date
Action
Notes
2024-12-31 Deleted Code deleted.
2020-01-01 Added Code added.
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