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Official Description

Injection, levetiracetam, 10 mg
Short Descr Levetiracetam injection
Related Drugs Keppra
Coverage Carrier Priced
Pricing Indicator(s) 51 – Drugs
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS O1E – Other drugs
TOS Code(s) 1 – Medical care
Added Date 1/1/2009
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 300
MUE 0
OTS Orthotic No
CCS Clinical Classification 240 - Medications (Injections, infusions and other forms)
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
GZ Item or service expected to be denied as not reasonable and necessary
GA Waiver of liability statement issued as required by payer policy, individual case
JZ Zero drug amount discarded/not administered to any patient
JW Drug amount discarded/not administered to any patient
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.
SA Nurse practitioner rendering service in collaboration with a physician
Date
Action
Notes
2009-01-01 Added -
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Description
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