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Official Description

Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries
Short Descr Flutemetamol f18 diagnostic
Related Drugs Vizamyl
Coverage Special coverage instructions apply
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
Processing Note IOM 100-3, CH 4, NCD 220.6.20.
BETOS I1E – Standard imaging - nuclear medicine
TOS Code(s) 4 – Diagnostic radiology
Added Date 7/1/2016
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 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 1
MUE Not applicable/unspecified.
OTS Orthotic No
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
GZ Item or service expected to be denied as not reasonable and necessary
JW Drug amount discarded/not administered to any patient
JZ Zero drug amount discarded/not administered to any patient
Date
Action
Notes
2016-07-01 Added Added
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Description
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