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Official Description

Oral magnetic resonance contrast agent, per 100 ml
Short Descr Oral mr contrast, 100 ml
Related Drugs GASTROMARK
Coverage Special coverage instructions apply
Pricing Indicator(s) 57 – Other carrier priced
MPI A – Not applicable, as HCPCS priced under one methodology
MCM 15022
BETOS I1F – Standard imaging - other
TOS Code(s) 4 – Diagnostic radiology
Added Date 4/1/2005
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 18
MUE Not applicable/unspecified.
IOM 100-04, 12, 70
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
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.
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
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
Date
Action
Notes
2005-04-01 Added Code added 4/1/2005
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