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Try CasePilot| Short Descr | Inj. eptinezumab-jjmr 1 mg | Related Drugs | Vyepti | Coverage | Carrier Priced | Pricing Indicator(s) | 51 – Drugs | MPI | A – Not applicable, as HCPCS priced under one methodology | ASC Payment Group Code | YY – 10/01/2020 | BETOS | O1E – Other drugs | TOS Code(s) | 1 – Medical care | Added Date | 10/1/2020 | 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 | 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 | GA | Waiver of liability statement issued as required by payer policy, individual case | JA | Administered intravenously | EJ | Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab | GX | Notice of liability issued, voluntary under payer policy | JG | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | SA | Nurse practitioner rendering service in collaboration with a physician | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | JW | Drug amount discarded/not administered to any patient | KX | Requirements specified in the medical policy have been met | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | SS | Home infusion services provided in the infusion suite of the iv therapy provider | TB | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2020-10-01 | Added | Code added. |
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