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Official Description

Injection, ganciclovir sodium, 500 mg
Short Descr Ganciclovir sodium injection
Related Drugs Ganciclovir
Coverage Special coverage instructions apply
Pricing Indicator(s) 51 – Drugs
MPI A – Not applicable, as HCPCS priced under one methodology
MCM 2049
BETOS O1E – Other drugs
TOS Code(s) 1 – Medical care
Added Date 1/1/1994
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 Items and Services Packaged into APC Rates
ASC Payment Indicator Packaged service/item; no separate payment made.
MUE 4
MUE 18
IOM 100-02, 15, 50
OTS Orthotic No
CCS Clinical Classification 240 - Medications (Injections, infusions and other forms)
KX Requirements specified in the medical policy have been met
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
GA Waiver of liability statement issued as required by payer policy, individual case
JW Drug amount discarded/not administered to any patient
LT Left side (used to identify procedures performed on the left side of the body)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
JB Administered subcutaneously
BR The beneficiary has been informed of the purchase and rental options and has elected to rent the item
GZ Item or service expected to be denied as not reasonable and necessary
KZ New coverage not implemented by managed care
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
1994-01-01 Added Code added 1/1/1994
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