HCPCS Code S9986

Official Description

Not medically necessary service (patient is aware that service not medically necessary)

Short Descr	Not medically necessary svc
Coverage	Not payable by Medicare
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	"S" CODES ARE UNIQUE TEMPORARY CODES ESTABLISHED BY BCBSA AND HIAA FOR PRIVATE PAYOR USE. THEY ARE NOT VALID NOR PAYABLE BY MEDICARE.
BETOS	Z2 – Undefined codes
TOS Code(s)	9 – Other medical items or services
Added Date	1/1/2002
Status Code	Not Valid for Medicare Purposes
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
MUE	Not applicable/unspecified.
MUE	Not applicable/unspecified.
OTS Orthotic	No
CCS Clinical Classification	237 - Ancillary Services

GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
LT	Left side (used to identify procedures performed on the left side of the body)
GX	Notice of liability issued, voluntary under payer policy
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).
51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
54	Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.
79	Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
GA	Waiver of liability statement issued as required by payer policy, individual case
RT	Right side (used to identify procedures performed on the right side of the body)