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Official Description

Injection, octafluoropropane microspheres, per ml
Short Descr Inj octafluoropropane mic,ml
Related Drugs Optison Perflutren Protein-Type A Microspheres
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 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 9
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 240 - Medications (Injections, infusions and other forms)
JW Drug amount discarded/not administered to any patient
JZ Zero drug amount discarded/not administered to any patient
GC This service has been performed in part by a resident under the direction of a teaching physician
CR Catastrophe/disaster related
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Date
Action
Notes
2005-04-01 Added Code added 4/1/2005
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