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Official Description

Pet imaging, any site, not otherwise specified
Short Descr Pet not otherwise specified
Coverage Non-covered 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')
CIM 50-36
ASC Payment Group Code YY – 1/01/2021
BETOS T2D – Other tests - other
TOS Code(s) 1 – Medical care
Added Date 1/1/2006
Status Code Non-Covered Service
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 1 - Diagnostic Tests for Radiology Services
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 Procedure or Service, Not Discounted when Multiple
ASC Payment Indicator Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.
MUE 1
MUE Not applicable/unspecified.
IOM 100-03, 4, 220.6
OTS Orthotic No
CCS Clinical Classification 210 - Other radioisotope scan
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
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
GZ Item or service expected to be denied as not reasonable and necessary
PI Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing
PS Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
Date
Action
Notes
2006-01-01 Added Code added 1/1/2006
Code
Description
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