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Official Description

Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary
Short Descr Dispense fee initial 30 day
Coverage Special coverage instructions apply
Pricing Indicator(s) 46 – Supplies And Surgical Dressings - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)
MPI A – Not applicable, as HCPCS priced under one methodology
Processing Note SECTION 303(e)(2) OF THE MMA IMPLEMENTS A SUPPLYING FEE FOR IMMUNOSUPPRESSIVE DRUGS, ORAL ANTI-CANCER CHEMOTHERAPEUTIC DRUGS, AND ANTI-EMETIC DRUGS USED AS PART OF AN ANTI-CANCER CHEMOTHERAPEUTIC REGIMEN.
BETOS D1E – Other DME
TOS Code(s) 9 – Other medical items or services
Added Date 1/1/2006
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
APC Status Indicator Items and Services Not Billable to the MAC
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 240 - Medications (Injections, infusions and other forms)
CR Catastrophe/disaster related
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KX Requirements specified in the medical policy have been met
Date
Action
Notes
2006-01-01 Added Code added 1/1/2006
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