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Official Description

Semen analysis; presence and/or motility of sperm excluding huhner
Short Descr Semen analysis
Coverage Carrier Priced
Pricing Indicator(s) 21 – Clinical Lab Fee Schedule - Price subject to national limitation amount
MPI A – Not applicable, as HCPCS priced under one methodology
Lab Cert(s) 400 – Hematology
BETOS T1H – Lab tests - other (non-Medicare fee schedule)
TOS Code(s) 5 – Diagnostic laboratory
Added Date 1/1/1995
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
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
CLIA Waived (QW) No
APC Status Indicator Conditionally packaged laboratory tests
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
CCS Clinical Classification 235 - Other Laboratory
Date
Action
Notes
1995-01-01 Added Code added 1/1/1995
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