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Official Description

Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen
Short Descr Transport port x-ray multipl
Coverage Special coverage instructions apply
Pricing Indicator(s) 13 – Physician Fee Schedule - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
MPI A – Not applicable, as HCPCS priced under one methodology
MCM 2070.4
BETOS I1F – Standard imaging - other
TOS Code(s) 4 – Diagnostic radiology
Added Date 1/1/1986
Status Code Carriers Price the Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 3 - Technical Component Only Code
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
MUE 2
MUE Not applicable/unspecified.
IOM 100-04, 13, 90
OTS Orthotic No
CCS Clinical Classification 239 - Transportation - patient, provider, equipment
UN Two patients served
UP Three patients served
UQ Four patients served
US Six or more patients served
UR Five patients served
GW Service not related to the hospice patient's terminal condition
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
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.
RT Right side (used to identify procedures performed on the right side of the body)
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
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.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
GA Waiver of liability statement issued as required by payer policy, individual case
LT Left side (used to identify procedures performed on the left side of the body)
QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
Action
Notes
1986-01-01 Added Code added 1/1/1986
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Description
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