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Official Description

Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg
Short Descr Tacrol envarsus ex rel oral
Related Drugs Envarsus XR
Coverage Special coverage instructions apply
Pricing Indicator(s) 51 – Drugs
MPI A – Not applicable, as HCPCS priced under one methodology
MCM 2049.5
BETOS O1E – Other drugs
TOS Code(s) 1 – Medical care
Added Date 1/1/2016
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 0
MUE 3600
IOM 100-02, 15, 50
OTS Orthotic No
KX Requirements specified in the medical policy have been met
GA Waiver of liability statement issued as required by payer policy, individual case
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
GW Service not related to the hospice patient's terminal condition
EY No physician or other licensed health care provider order for this item or service
GZ Item or service expected to be denied as not reasonable and necessary
Date
Action
Notes
2016-01-01 Added Added
Code
Description
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