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Try CasePilot| Short Descr | Darbepoetin alfa, esrd use | Related Drugs | ARANESP | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 57 – Other carrier priced | MPI | A – Not applicable, as HCPCS priced under one methodology | MCM | 4273.1 | ASC Payment Group Code | YY – 1/01/2017 | BETOS | O1E – Other drugs | TOS Code(s) | 1 – Medical care | Added Date | 1/1/2006 | Status Code | Excluded from Physician Fee Schedule by Regulation | 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 | Drugs and biologicals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate. | MUE | 300 | MUE | 0 | IOM | 100-02, 6, 10 | OTS Orthotic | No | CCS Clinical Classification | 240 - Medications (Injections, infusions and other forms) |
| JB | Administered subcutaneously | EC | Erythropoetic stimulating agent (esa) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy | JZ | Zero drug amount discarded/not administered to any patient | EE | Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle | 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. | UD | Medicaid level of care 13, as defined by each state | EA | Erythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer chemotherapy | CR | Catastrophe/disaster related | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | KP | First drug of a multiple drug unit dose formulation | KQ | Second or subsequent drug of a multiple drug unit dose formulation | JW | Drug amount discarded/not administered to any patient |
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| 2006-01-01 | Added | Code added 1/1/2006 |
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