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Official Description

Injection, sulfur hexafluoride lipid microspheres, per ml
Short Descr Inj sulf hexa lipid microsph
Related Drugs Lumason
Coverage Carrier Priced
Pricing Indicator(s) 57 – Other carrier priced
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS I1F – Standard imaging - other
TOS Code(s) 4 – Diagnostic radiology
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 5
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
JW Drug amount discarded/not administered to any patient
JZ Zero 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.
GA Waiver of liability statement issued as required by payer policy, individual case
KP First drug of a multiple drug unit dose formulation
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
Date
Action
Notes
2024-01-01 Note Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)
2016-01-01 ReActivated Recycled code. New description.
2016-01-01 Added Code added 1/1/2016
2008-01-01 Deleted Code Deleted effective 01/01/2008.
2005-04-01 Added Code Added 04/01/2005.
Code
Description
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