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Try CasePilot| Short Descr | Hiv prep, inj, cabotegravir | Related Drugs | Apretude | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 57 – Other carrier priced | MPI | A – Not applicable, as HCPCS priced under one methodology | MCM | 2049 | Statute | 1861(ddd) | BETOS | O1E – Other drugs | TOS Code(s) | 1 – Medical care | Added Date | 7/1/2022 | 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 | Nonpass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals | ASC Payment Indicator | Unclassified drugs and biologicals; payment contractor-priced. | MUE | 600 | MUE | Not applicable/unspecified. | OTS Orthotic | No |
| JZ | Zero drug amount discarded/not administered to any patient | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 33 | Preventive services: when the primary purpose of the service is the delivery of an evidence based service in accordance with a us preventive services task force a or b rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. for separately reported services specifically identified as preventive, the modifier should not be used. | UD | Medicaid level of care 13, as defined by each state | CR | Catastrophe/disaster related | GZ | Item or service expected to be denied as not reasonable and necessary | JB | Administered subcutaneously |
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| 2024-01-01 | Changed | Long description changed |
| 2024-01-01 | Note | Coverage data changed |
| 2023-01-01 | Added | First appearance in codebook. |
| 2022-07-01 | Added | Code added. |
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