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Try CasePilot| Short Descr | Daratumumab, hyaluronidase | Related Drugs | Darzalex Faspro | Coverage | Carrier Priced | Pricing Indicator(s) | 51 – Drugs | MPI | A – Not applicable, as HCPCS priced under one methodology | ASC Payment Group Code | YY – 1/01/2021 | BETOS | O1D – Chemotherapy | TOS Code(s) | 1 – Medical care | Added Date | 1/1/2021 | 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 | 180 | MUE | Not applicable/unspecified. | OTS Orthotic | No |
| JZ | Zero drug amount discarded/not administered to any patient | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | 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 | JG | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | JW | Drug amount discarded/not administered to any patient | CR | Catastrophe/disaster related | EJ | Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab | JB | Administered subcutaneously | UD | Medicaid level of care 13, as defined by each state | GW | Service not related to the hospice patient's terminal condition | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | TB | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GA | Waiver of liability statement issued as required by payer policy, individual case | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q5 | Service furnished under a reciprocal billing 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 | 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. | JA | Administered intravenously | KX | Requirements specified in the medical policy have been met | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2021-01-01 | Added | Code added. |
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