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Official Description

Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)
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
Date
Action
Notes
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.
Code
Description
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