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Official Description

Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg
Short Descr Lymphocyte immune globulin
Related Drugs Atgam
Coverage Special coverage instructions apply
Pricing Indicator(s) 51 – Drugs
MPI A – Not applicable, as HCPCS priced under one methodology
CIM 45-22
MCM 2049
ASC Payment Group Code YY – 1/01/2008
BETOS O1E – Other drugs
TOS Code(s) 1 – Medical care
Added Date 1/1/1988
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
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 15
MUE 0
IOM 100-02, 15, 50
OTS Orthotic No
CCS Clinical Classification 240 - Medications (Injections, infusions and other forms)
Date
Action
Notes
1988-01-01 Added Code added 1/1/1988
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