PROGRAM MEMORANDUM
INTERMEDIARIES
Department of Health
and Human Services
Health Care Financing Administration
PM Rev. No. A-00-42
Date: JULY 26, 2000
CHANGE REQUEST 1259
SUBJECT: Coding Information for Hospital Outpatient Prospective Payment System
Introduction
The purpose of this Program Memorandum (PM) is to provide hospitals coding information related to the Outpatient Prospective Payment System.
Section I contains a list of HCFA Common Procedure Coding System (HCPCS) codes and long descriptors for drugs, biologicals, and devices eligible for transitional pass through payments, and for services and items classified in "new technology" APCs. Section II contains a list of devices that are classified in "new technology" APCs. Section III contains a list of short descriptor changes. Section IV contains a list of blood/blood products and drugs that are not eligible for the transitional pass-through payment system but are classified in separate APCs. Section V provides information on the appropriate code for reporting stereotactic radiosurgery under the Outpatient Prospective Payment System. Section VI provides information on two additional "new technology" APCs and their payment rates. Sections I, III, IV, and V are effective August 1, 2000. Sections II and VI are effective October 1, 2000.
The listing of HCPCS codes contained in this instruction does not assure coverage of the specific item or service. To be eligible for payment, the items contained in this document must be considered reasonable and necessary.
I. Drugs, Biologics, Devices, and New Technology Services effective August 1, 2000
HCPCS
CODE LONG DESCRIPTORS
1 Other devices may be used for this code (see pages 14 - 17).
2 Changed from the short descriptor list posted on HCFA’s web site on May 12, 2000 (see page 20).
3 New technology.
CPT codes and descriptors are copyright of the American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
|
365503 |
Declotting by thrombolytic agent of implanted vascular access device or catheter |
|
538503 |
Transurethral destruction of prostate tissue; by microwave thermotherapy |
|
538523 |
Transurethral destruction of prostate tissue; by radiofrequency thermotherapy |
|
775203 |
Proton beam delivery to a single treatment area, single port, custom block, with or without compensation, with treatment set-up and verification images
|
|
775233 |
Proton beam delivery to one or two treatment areas, two or more ports, two or more custom blocks, and two or more compensators, with treatment set-up and verification images
|
HCFA-Pub. 60A
|
965703 |
Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes |
|
965713 |
Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes |
|
A4642 |
Supply of satumomab pendetide, radiopharmaceutical diagnostic imaging agent, per dose |
|
A9500 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m sestamibi, per dose |
|
A9502 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m tetrofosmin, per unit dose
|
|
A9503 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m medronate, up to 30 mCi
|
|
A9504 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m apcitide |
|
A9505 |
Supply of radiopharmaceutical diagnostic imaging agent, thallous chloride TL 201, per mCi |
|
A9507 |
Supply of radiopharmaceutical diagnostic imaging agent, IN 111 capromab pendetide, per dose |
|
A9600 |
Supply of therapeutic radiopharmaceutical, strontium-89 chloride, per mCi |
|
A9605 |
Supply of therapeutic radiopharmaceutical, samarium sm 153 lexidronamm, 50 mCi |
|
C1000 |
Closure, arterial vascular device, Perclose Closer Arterial Vascular Closure Device, Prostar Arterial Vascular Closure Device |
|
C1001 |
Catheter, diagnostic ultrasound, AcuNav Diagnostic Ultrasound Catheter |
|
C10051 |
Intraocular lens, Sensar Soft Acrylic Ultraviolet Light Absorbing Posterior Chamber Intraocular Lens
|
|
C1006 |
Intraocular lens, Array Multifocal Silicone Posterior Chamber Intraocular Lens |
|
C10071 |
Prosthesis, penile, AMS 700 Penile Prosthesis |
|
C1008 |
Stent, urethral, permanent, UroLume |
|
C1024 |
Quinopristin/dalfopristin, 10 ml, Synercid I.V. |
|
C10251 |
Catheter, diagnostic, electrophysiology, Marinr CS |
|
C10261 |
Catheter, ablation, RF Performr, 5F RF Marinr |
|
C10271,2 |
Stent, coronary, Magic Wallstent Extra Short or Short Coronary Self Expanding Stent with Delivery System, Radius 14mm Self Expanding Stent with Over the Wire Delivery System
|
|
C10281 |
Sling fixation system for treatment of stress urinary incontinence, Precision Twist Transvaginal Anchor System , Precision Tack Transvaginal Anchor System, Vesica Press-In Anchor System, Capio CL (TVB/S) Transvaginal Suturing Device
|
|
C1029 |
Catheter, balloon dilatation, Controlled Radial Expansion Balloon Dilatation Catheter Wire-Guided and Fixed Wire
|
|
C10301 |
Catheter, balloon dilatation, Marshal, Blue Max 20, Ultra-Thin Diamond |
|
C1031 |
Electrode, needle, ablation, MR Compatible LeVeen, Modified LeVeen Needle Electrode |
|
C10331 |
Catheter, imaging, Sonicath Ultra Model 37-410 Ultrasound Imaging Catheter |
|
C1034 |
Catheter,coronary angioplasty, SURPASS Superfusion Catheter, Long 30 SURPASS Superfusion Catheter
|
|
C10361 |
Port/reservoir, venous access device, Vaxcel Implantable Vascular Access System, R Port Premier Kit
|
|
C1037 |
Catheter, dialysis, Vaxcel Chronic Dialysis Catheter
|
|
C10391,2 |
Stent, tracheobronchial, Wallstent Tracheobronchial Endoprosthesis (covered), Wallstent Tracheobronchial Endoprosthesis with Permalume Covering and Unistep Plus Delivery System
|
|
C10401 |
Stent, self-expandable for creation of intrahepatic shunts, Wallstent Transjugular Intrahepatic Portosystemic Shunt (TIPS) with Unistep Plus Delivery System (20/40/60 mm in length)
|
|
C10421,2 |
Stent, biliary, Wallstent Biliary Endoprosthesis with Unistep Plus Delivery System, Wallstent Biliary Endoprosthesis with Unistep Delivery System (Biliary Stent and Catheter), Ultraflex Diamond Biliary Stent System, New Microvasive Biliary Stent and Delivery System
|
|
C10431,2 |
Atherectomy system, coronary, RotablatorRotaLink Atherectomy Catheter and Burr, Rotablator RotaLink Rotational Atherectomy System Advancer and Guide Wire
|
|
C1045 |
Supply of radiopharmaceutical diagnostic imaging agent, I-131 MIBG [iobenguane sulfate I-131], per 0.5 mCi
|
|
C1047 |
Catheter, diagnostic, Navi-Star Diagnostic Deflectable Tip Catheter, NOGA-STAR Diagnostic Deflectable Tip Catheter
|
|
C1048 |
Generator, bipolar pulse, Cyberonics NeuroCybernetic Prosthesis Generator |
|
C1050 |
Protein A immunoadsorption, PROSORBA Column |
|
C1053 |
Catheter, diagnostic, EnSite 3000 Catheter |
|
C1057 |
Tissue marker, 11-Gauge MicroMark II Tissue Marker |
|
C1059 |
Autologous cultured chondrocytes, implantation, Carticel |
|
C1060 |
Stent, coronary, ACS Multi-Link Tristar Coronary Stent System and Delivery System |
|
C1061 |
Catheter, coronary guide, ACS Viking Guiding Catheter |
|
C1063 |
Lead, defibrillator, Endotak Endurance EZ, Endotak Endurance RX |
|
C1067 |
Stent, biliary, MEGALINK Biliary Stent |
|
C1068 |
Pacemaker, dual chamber, Pulsar DDD |
|
C10691 |
Pacemaker, dual chamber, Discovery DR |
|
C1071 |
Pacemaker, single chamber, Pulsar Max SR, Pulsar SR |
|
C10722 |
Catheter, balloon dilatation, coronary, RX Esprit, RX Gemini, RX Solaris, OTW Photon, OTW Solaris
|
|
C10732 |
Morcellator, laparascopic, Gynecare X-tract Laparascopic Morcellator |
|
C1074 |
Catheter, peripheral dilatation, RX Viatrac 14 Peripheral Dilatation Catheter, OTW Viatrac 18 Peripheral Dilatation Catheter
|
|
C1075 |
Lead, pacemaker, Selute Picotip, Selute, Sweet Picotip Rx, Sweet Tip Rx, FineLine, FineLine EZ, ThinLine, ThinLine EZ
|
|
C10762 |
Defibrillator, single chamber, automatic, implantable, Ventak Mini IV, Ventak Mini III HE, Ventak Mini III
|
|
C10772 |
Defibrillator, single chamber, automatic, implantable, Ventak Prizm VR, Ventak VR |
|
C10781,2 |
Defibrillator, dual chamber, automatic, implantable, Ventak Prizm, Ventak AV III DR
|
|
C1079 |
Supply of radiopharmaceutical diagnostic imaging agent, cyanocobalamin Co 58/57, kit, 0.5 mCi, Nycomed Cyanoco Co57/Cyanoco Co58
|
|
C1084 |
Denileukin diftitox, 300 mcg, Ontak IV |
|
C1086 |
Temozolomide, 5 mg, Temodar |
|
C1087 |
Supply of radiopharmaceutical imaging agent, sodium iodide I-123 (capsule), per uCi |
|
C10883 |
Laser optic treatment system, Indigo LaserOptic Treatment System |
|
C1089 |
Supply of radiopharmaceutical diagnostic imaging agent, cyanocobalamin Co 57, 0.5 mCi, capsule
|
|
C1090 |
Supply of radiopharmaceutical diagnostic imaging agent, indium IN 111 chloride, per mCi |
|
C1091 |
Supply of radiopharmaceutical diagnostic imaging agent, indium IN 111 oxyquinoline, per 5 mCi |
|
C1092 |
Supply of radiopharmaceutical diagnostic imaging agent, indium IN 111 pentetate disodium, per 1.5 mCi
|
|
C1094 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m albumin aggregated, per vial
|
|
C1095 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m depreotide, per vial
|
|
C1096 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m exametazime, per dose
|
|
C1097 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m mebrofenin, per vial |
|
C1098 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m pentetate, per vial
|
|
C1099 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m pyrophosphate, per vial
|
|
C11001 |
Guide wire, percutaneous transluminal coronary angioplasty, Medtronic AVE GT1Guide Wire |
|
C1101 |
Catheter, percutaneous transluminal coronary angioplasty guide, Medtronic AVE 5F, 6F, 7F, 8F, 9F Zuma Guide Catheter
|
|
C1102 |
Generator, pulse, neurostimulator, Medtronic Synergy Neurostimulator Generator and Extension |
|
C1103 |
Defibrillator, implantable, Micro Jewel, Micro Jewel II |
|
C11041 |
Catheter, ablation, RF Conductr MC |
|
C1105 |
Pacemaker, dual chamber, Sigma 300 VDD |
|
C1106 |
Neurostimulator, patient programmer, Synergy EZ Patient Programmer |
|
C1107 |
Catheter, diagnostic, electrophysiology, Torqr, Soloist |
|
C1109 |
Anchor, implantable, Mitek GII Anchor, Mitek Knotless, Mitek TACIT, Mitek Rotator Cuff, Mitek GLS, Mitek Mini, Mitek FASTIN, Mitek Super, Mitek PANALOK, Mitek Micro, Mitek PANALOK RC, Mitek FASTIN RC, Innovasive ROC EZ, Innovasive MINIROC, Innovasive BIOROC, Innovasive ROC XS, Innovasive Contack
|
|
C1110 |
Catheter, diagnostic, electrophysiology, Stable Mapper |
|
C1111 |
Stent graft system, AneuRx Aorto-Uni-Iliac-Stent Graft System |
|
C11121 |
Stent graft system, AneuRx Stent Graft System |
|
C1113 |
Stent graft system, Talent Endoluminal Spring Stent Graft System |
|
C1114 |
Stent graft system, Talent Spring Stent Graft System |
|
C1115 |
Lead, pacemaker, 5038S, 5038, 5038L |
|
C1116 |
Lead, pacemaker, CapSure SP Novus, CapSure SP, Capsure, Excellence +, S+, PS+, CapSure Z Novus, CapSure Z, Impulse
|
|
C1118 |
Pacemaker, dual chamber, Sigma 300 DR, Legacy II DR |
|
C1119 |
Lead, defibrillator, Sprint 6932, Sprint 6943 |
|
C1120 |
Lead, defibrillator, Sprint 6942, Sprint 6945 |
|
C1121 |
Defibrillator, implantable, GEM |
|
C1122 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m arcitumomab, per vial
|
|
C1123 |
Defibrillator, implantable, GEM II VR |
|
C1124 |
Lead, neurostimulator, kit, InterStim Test Stimulation Lead Kit |
|
C1125 |
Pacemaker, single chamber, Kappa 400 SR, Topaz II SR |
|
C1126 |
Pacemaker, dual chamber, Kappa 700 DR (all models) |
|
C1127 |
Pacemaker, single chamber, Kappa 700 SR |
|
C1128 |
Pacemaker, dual chamber, Kappa 700 D, Ruby II D |
|
C1129 |
Pacemaker, Kappa 700 VDD |
|
C1130 |
Pacemaker, dual chamber, Sigma 200 D, Legacy II D |
|
C1131 |
Pacemaker, dual chamber, Sigma 200 DR |
|
C11321 |
Pacemaker, single chamber, Sigma 200 SR, Legacy II SR |
|
C1133 |
Pacemaker, single chamber, Sigma 300 SR, Vita SR |
|
C1134 |
Pacemaker, dual chamber, Sigma 300 D |
|
C1137 |
Septal defect implant system, CardioSEAL Septal Occlusion System, CardioSEAL Occluder Delivery Catheter
|
|
C1143 |
Pacemaker, dual chamber, AddVent 2060BL |
|
C1144 |
Pacemaker, single chamber, rate-responsive, Affinity SR 5130L, Affinity 5130R, Integrity SR 5142
|
|
C11451,2 |
Vascular closure device, Angio-Seal 6 French Vascular Closure Device 610091, Angio-Seal 8 French Vascular Closure Device 610089
|
|
C11462 |
Endotracheal tube, VETT Endotracheal Tube |
|
C1147 |
Lead, pacemaker, AV Plus DX 1368/52, AV Plus DX 1368/58 |
|
C1148 |
Defibrillator, single chamber, implantable, Contour MD V-175, Contour MD V-175A, Contour MD V-175AC, Contour MD V-175B, Contour MD V-175C, Contour MD V-175D
|
|
C1149 |
Pacemaker, dual chamber, Entity DC 5226R |
|
C11512 |
Lead, pacemaker, Passive Plus DX 1343K/46, Passive Plus DX 1343K/52, Passive Plus DX 1345K/52, Passive Plus DX 1345K/58, Passive Plus DX 1336T/52, Passive Plus DX 1336T/58, Passive Plus DX 1342T/46, Passive Plus DX 1342T/52, Passive Plus DX 1346T/52, Passive Plus DX 1346T/58
|
|
C11522 |
Access system, dialysis, LifeSite Access System |
|
C11531 |
Pacemaker, single chamber, Regency SC+ 2402L |
|
C1154 |
Lead, defibrillator, SPL SP01, SPL SP02, SPL SP04 |
|
C11551 |
Repliform Tissue Regeneration Matrix, per 8 square centimeters
|
|
C1156 |
Pacemaker, single chamber, Affinity SR 5131M/S, Tempo VR 1102, Trilogy SR+ 2260L, Trilogy SR+ 2264L
|
|
C1157 |
Pacemaker, dual chamber, Trilogy DC+ 2318L |
|
C1158 |
Lead, defibrillator, TVL SV01, TVL SV02, TVL SV04 |
|
C1159 |
Lead, defibrillator, TVL RV02, TVL06, TVL07 |
|
C1160 |
Lead, defibrillator, TVL-ADX 1559/65 |
|
C1161 |
Lead, pacemaker, Tendril DX 1388K/46, Tendril DX 1388K/52, Tendril DX 1388K/58, Tendril DX 1388T/46, Tendril DX 1388T/52, Tendril DX 1388T/58, Tendril DX 1388T/85, Tendril DX 1388T/100, Tendril DX 1388TC/46, Tendril DX 1388TC/52, Tendril DX 1388TC/58
|
|
C11621,2 |
Pacemaker, dual-chamber, Affinity DR 5331 M/S, Tempo DR 2102, Trilogy DR+ 2360L, Trilogy DR + 2364L
|
|
C1163 |
Lead, pacemaker, Tendril SDX 1488T/46, Tendril SDX 1488T/52, Tendril SDX 1488T/58, Tendril SDX 1488TC/46, Tendril SDX 1488TC/52, Tendril SDX 1488TC/58
|
|
C1164 |
Brachytherapy seed, intracavity, I-125 seeds |
|
C1166 |
Injection, cytarabine liposome, 10 mg, Depocyt/Liposomal Cytarabine |
|
C1167 |
Injection, epirubicin hydrochloride, 2mg |
|
C11701 |
Biopsy device, breast, ABBI Device |
|
C1171 |
Site marker device, disposable, Auto Suture SITE MARKER Device |
|
C1172 |
Balloon, tissue dissector, Spacemaker Tissue Dissection Balloon |
|
C11731 |
Stent, coronary, S540 Over-the-Wire Coronary Stent System, S670 with Discrete Technology Over-the-Wire Coronary Stent System, S670 with Discrete Technology Rapid Exchange Coronary Stent System
|
|
C11741 |
Needle, brachytherapy, Bard BrachyStar Brachytherapy Needle |
|
C1178 |
Injection, Busulfan (Busulfex I.V.) per 6mg |
|
C1188 |
Sodium iodide I-131, per uCi |
|
C1200 |
Supply of radiological diagnostic imaging agent, technetium Tc 99m sodium glucoheptonate, per vial
|
|
C1201 |
Supply of radiological diagnostic imaging agent, technetium Tc 99m succimer, per vial |
|
C1202 |
Supply of radiological diagnostic imaging agent, technetium Tc 99m sulfur colloid, per dose |
|
C1203 |
Injection, Visudyne (verteporfin) |
|
C1205 |
Supply of radiological diagnostic imaging agent, technetium Tc 99m disofenin, per vial |
|
C1207 |
Octreotide acetate 1 mg |
|
C13003 |
Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval |
|
C13022 |
Lead, defibrillator, TVL SQ01 |
|
C1304 |
Catheter, imaging, Sonicath Ultra Model 37-416 Ultrasound Imaging Catheter, Sonicath Ultra Model 37-418 Ultrasound Imaging Catheter
|
|
C13052 |
Apligraf, per 44 square centimeters |
|
C13061 |
Lead, neurostimulator, Cyberonics NeuroCybernetic Prosthesis Lead |
|
C1311 |
Pacemaker, dual chamber, Trilogy DR+/DAO |
|
C1312 |
Stent, coronary, Magic Wallstent Mini Coronary Self Expanding Stent with Delivery System |
|
C13132 |
Stent, coronary, Magic Wallstent Medium Coronary Self Expanding Stent with Delivery System, Radius 31mm Self Expanding Stent with Over the Wire Delivery System
|
|
C1314 |
Stent, coronary, Magic Wallstent Long Coronary Self Expanding Stent with Delivery System |
|
C1315 |
Pacemaker, dual chamber, Vigor DR, Meridian DR |
|
C1316 |
Pacemaker, dual chamber, Meridian DDD |
|
C1317 |
Pacemaker, single chamber, Discovery SR |
|
C13181 |
Pacemaker, single chamber, Meridian SR |
|
C13191,2 |
Stent, enteral, Wallstent Enteral Endoprosthesis and Unistep Delivery System (60mm in length) |
|
C13202 |
Stent, iliac, Wallstent Iliac Endoprosthesis with Unistep Plus Delivery System |
|
C13241 |
Electrode, disposable, LigaSure Disposable Electrode |
|
C1325 |
Brachytherapy seed, intracavity, Palladium-103 seeds |
|
C13261 |
Catheter, thrombectomy, AngioJet Rheolytic Thrombectomy Catheter |
|
C13281,2 |
External transmitter, neurostimulation system, ANS Renew Spinal Cord Stimulator System |
|
C1333 |
Stent, biliary, PALMAZ Corinthian Transhepatic Biliary Stent and Delivery System |
|
C13342 |
Stent, coronary, PALMAZ-Schatz Crown Stent, Mini-Crown Stent, CrossFlex LC Stent |
|
C13351,2 |
Mesh, hernia, PROLENE Polypropylene Hernia System |
|
C13361,2 |
Infusion pump, implantable, non-programmable, Constant Flow Implantable Pump Model 3000 |
|
C1348 |
Sodium iodide I-131, per mCi |
|
C1350 |
Brachytherapy, per source, ProstaSeed I-125 |
|
C1351 |
Lead, pacemaker, CapSureFix, SureFix, Pirouet +, S+ |
|
C13521 |
Defibrillator, dual chamber, implantable, Gem II DR |
|
C1353 |
Neurostimulator, implantable, Itrel II/Soletra Implantable Neurostimulator and Extension, Itrel III Implantable Neurostimulator and Extension, InterStim Neurostimulator (implantable) and Extension
|
|
C1354 |
Pacemaker, dual chamber, Kappa 400 DR, Diamond II 820 DR |
|
C1355 |
Pacemaker, dual chamber, Kappa 600 DR, Vita DR |
|
C1356 |
Defibrillator, single chamber, implantable, Profile MD V-186HV3 |
|
C1357 |
Defibrillator, single chamber, implantable, Angstrom MD V-190HV3 |
|
C1358 |
Pacemaker, dual chamber, Affinity DC 5230R |
|
C13591 |
Pacemaker, dual chamber, Pulsar DR, Pulsar Max DR |
|
C1360 |
Ocular photodynamic therapy |
|
C1361 |
Recorder, cardiac event, implantable, Reveal, Reveal Plus |
|
C1362 |
Stent, biliary, RX HERCULINK 14 Biliary Stent, OTW MEGALINK SDS Biliary Stent |
|
G01253 |
PET lung imaging of solitary pulmonary nodules, using 2-(fluorine-18)-fluoro-2-deoxy-d-glucose (FDG), following CT (71250/71260 or 71270) |
|
G01263 |
PET lung imaging of solitary pulmonary nodules, using 2-(fluorine-18)-fluoro-2-deoxy-d-glucose (FDG), following CT (71250/71260 or 71270); initial staging of pathologically diagnosed non-small cell lung cancer |
|
G01603 |
Cryosurgical ablation of localized prostate cancer, primary treatment only (post operative irrigations and aspiration of sloughing tissue included)
|
|
G01633 |
Positron emission tomography (PET), whole body; for recurrence of colorectal metastatic cancer |
|
G01643 |
Positron emission tomography (PET), whole body; for staging and characterization of lymphoma |
|
G01653 |
Positron emission tomography (PET), whole body; for recurrence of melanoma or melanoma metastatic cancer |
|
G01663 |
External counterpulsation, per treatment session |
|
G01683 |
Wound closure by adhesive |
|
J0130 |
Injection, abciximab, 10 mg |
|
J0205 |
Injection, alglucerase, per 10 units |
|
J0207 |
Injection, amifostine, 500 mg |
|
J0256 |
Injection, alpha 1-proteinase inhibitor--human, 10 mg |
|
J0286 |
Injection, amphotericin B, any lipid formulation, 50 mg |
|
J0350 |
Injection, anistreplase, per 30 units |
|
J0476 |
Baclofen intrathecal trial, 50 mcg |
|
J0585 |
Botulinum toxin, type A, per unit |
|
J0640 |
Injection, leucovorin calcium, per 50 mg |
|
J0850 |
Injection, cytomegalovirus immune globulin intravenous (human), per vial |
|
J1190 |
Injection, dexrazoxane hydrochloride, per 250 mg |
|
J1260 |
Injection, dolasetron mesylate, 10 mg |
|
J1325 |
Injection, epoprostenol, 0.5 mg |
|
J1327 |
Injection, eptifibatide, 5 mg |
|
J1436 |
Injection, etidronate disodium, per 300 mg |
|
J1438 |
Injection, etanercept, 25 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
|
|
J1440 |
Injection, filgrastim (G-CSF), 300 mcg |
|
J1561 |
Injection, immune globulin, intravenous, 500 mg |
|
J1562 |
Injection, immune globulin, intravenous, 5 gms |
|
J1565 |
Injection, respiratory syncytial virus immune globulin, intravenous, 50 mg |
|
J1620 |
Gonadorelin hcl, 100 mcg |
|
J1626 |
Injection, granisetron hydrochloride, 100 mcg |
|
J1670 |
Injection, tetanus immune globulin, human, up to 250 units |
|
J1745 |
Injection, infliximab, 10 mg |
|
J1785 |
Injection, imiglucerase, per unit |
|
J1825 |
Injection, interferon beta-1a, 33mcg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
|
|
J1830 |
Injection, interferon beta-1b, 0.25 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
|
|
J1950 |
Injection, leuprolide acetate (for depot suspension), per 3.75 mg |
|
J2275 |
Injection, morphine sulfate (preservative-free sterile solution), per 10 mg |
|
J2352 |
Injection, octreotide acetate, 1 mg |
|
J2355 |
Injection, oprelvekin, 5 mg |
|
J2405 |
Injection, ondansetron HCl, per 1 mg |
|
J2430 |
Injection, pamidronate disodium, per 30 mg |
|
J2765 |
Injection, metoclopramide HCl, up to 10 mg |
|
J2790 |
Injection, Rho (D) immune globulin, human, one dose package |
|
J2792 |
Injection, Rho (D) immune globulin, intravenous, human, solvent detergent, 100 I.U. |
|
J2820 |
Injection, sargramostim (GM-CSF), 50 mcg |
|
J3010 |
Injection, fentanyl citrate, up to 2 ml |
|
J3240 |
Injection, thyrotropin alfa, 0.9 mg |
|
J3245 |
Injection, tirofiban hydrochloride, 12.5 mg |
|
J3280 |
Injection, thiethylperazine maleate, up to 10 mg |
|
J3305 |
Injection, trimetrexate glucuronate, per 25 mg |
|
J7190 |
Factor VIII (antihemophilic factor, human), per I.U. |
|
J7191 |
Factor VIII (antihemophilic factor, (porcine)), per I.U. |
|
J7192 |
Factor VIII (antihemophilic factor, recombinant), per I.U. |
|
J7194 |
Factor IX, complex, per IU |
|
J7197 |
Antithrombin III (human), per IU |
|
J7198 |
Anti-inhibitor, per I.U. |
|
J7310 |
Ganciclovir, 4.5 mg, long-acting implant |
|
J7315 |
Sodium hyaluronate for intra articular injection, 20 mg |
|
J7320 |
Hylan G-F 20, 16 mg, for intra articular-injection |
|
J7500 |
Azathioprine, oral, 50 mg |
|
J7501 |
Azathioprine, parenteral, 100 mg |
|
J7502 |
Cyclosporine, oral, 100 mg |
|
J7504 |
Lymphocyte immune globulin, antithymocyte globulin, parenteral, 250 mg |
|
J7505 |
Muromonab-CD3, 5 mg |
|
J7507 |
Tacrolimus oral per 1 mg |
|
J7513 |
Daclizumab, parenteral, 25 mg |
|
J7516 |
Cyclosporin, parenteral, 250 mg |
|
J8510 |
Busulfan; oral, 2 mg |
|
J8520 |
Capecitabine, oral, 150 mg |
|
J8530 |
Cyclophosphamide, oral, 25 mg |
|
J8560 |
Etoposide, oral, 50 mg |
|
J8600 |
Melphalan, oral, 2 mg |
|
J8610 |
Methotrexate, oral, 2.5 mg |
|
J9000 |
Doxorubicin HCl, 10 mg |
|
J9001 |
Doxorubicin hydrochloride, all lipid formulations, 10 mg |
|
J9015 |
Aldesleukin, per single use vial |
|
J9020 |
Asparaginase, 10,000 units |
|
J9031 |
BCG (intravesical), per installation |
|
J9040 |
Bleomycin sulfate, 15 units |
|
J9045 |
Carboplatin, 50 mg |
|
J9050 |
Carmustine, 100 mg |
|
J9060 |
Cisplatin, powder or solution, per 10 mg |
|
J9065 |
Injection, cladribine, per 1 mg |
|
J9070 |
Cyclophosphamide, 100 mg |
|
J9093 |
Cyclophosphamide, lyophilized, 100 mg |
|
J9100 |
Cytarabine, 100 mg |
|
J9120 |
Dactinomycin, 0.5 mg |
|
J9130 |
Dacarbazine, injection, 100 mg |
|
J9150 |
Daunorubicin HCl, 10 mg |
|
J9151 |
Daunorubicin citrate, liposomal formulation, 10 mg |
|
J9165 |
Diethylstilbestrol diphosphate, 250 mg |
|
J9170 |
Docetaxel, 20 mg |
|
J9181 |
Etoposide, 10 mg |
|
J9185 |
Fludarabine phosphate, 50 mg |
|
J9190 |
Fluorouracil, 500 mg |
|
J9200 |
Floxuridine, 500 mg |
|
J9201 |
Gemcitabine HCl, 200 mg |
|
J9202 |
Goserelin acetate implant, per 3.6 mg |
|
J9206 |
Irinotecan, 20 mg |
|
J9208 |
Ifosfamide, 1 gm |
|
J9209 |
Mesna, 200 mg |
|
J9211 |
Idarubicin HCl, 5 mg |
|
J9212 |
Injection, interferon Alfacon-1, recombinant, 1 mcg |
|
J9213 |
Interferon, alfa-2A, recombinant, 3 million units |
|
J9214 |
Interferon, alfa-2B, recombinant, 1 million units |
|
J9215 |
Interferon, alfa-N3, (human leukocyte derived), 250,000 IU |
|
J9216 |
Interferon, gamma 1-B, injection, 3 million units |
|
J9218 |
Leuprolide acetate, per 1 mg |
|
J9230 |
Mechlorethamine HCl (nitrogen mustard), 10 mg |
|
J9245 |
Injection, melphalan HCl, 50 mg |
|
J9250 |
Methotrexate sodium, 5 mg |
|
J9265 |
Paclitaxel, 30 mg |
|
J9266 |
Pegaspargase, per single dose vial |
|
J9268 |
Pentostatin, per 10 mg |
|
J9270 |
Plicamycin, 2.5 mg |
|
J9280 |
Mitomycin, 5 mg |
|
J9293 |
Injection, mitoxantrone HCl, per 5 mg |
|
J9310 |
Rituximab, 100 mg |
|
J9320 |
Streptozocin, injection, 1 g |
|
J9340 |
Thiotepa, 15 mg |
|
J9350 |
Topotecan, 4 mg |
|
J9355 |
Trastuzumab, 10 mg |
|
J9357 |
Valrubicin, intravesical, 200 mg |
|
J9360 |
Vinblastine sulfate, 1 mg |
|
J9370 |
Vincristine sulfate, 1 mg |
|
J9390 |
Vinorelbine tartrate, per 10 mg |
|
J9600 |
Porfimer sodium, 75 mg |
|
L8614 |
Cochlear device/system |
|
Q0136 |
Injection, epoetin alpha, (for non-ESRD use), per 1000 units |
|
Q0160 |
Factor IX (antihemophic factor, purified, non-recombinant), per I.U. |
|
Q0161 |
Factor IX (antihemophic factor, non-recombinant), per I.U. |
|
Q0163 |
Diphenhydramine hydrochloride, 50 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0164 |
Prochlorperazine maleate, 5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0166 |
Granisetron hydrochloride, 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0167 |
Dronabinol, 2.5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0169 |
Promethazine hydrochloride, 12.5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0171 |
Chlorpromazine hydrochloride, 10 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0173 |
Trimethobenzamide hydrochloride, 250 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0174 |
Thiethylperrazine maleate, 10 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen |
|
Q0175 |
Perphenazine, 4 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0177 |
Hydroxyzine pamoate, 25 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen |
|
Q0179 |
Ondansetron hydrochloride, 8 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0180 |
Dolasetron mesylate, 100 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen
|
|
Q0181 |
Unspecified oral anti-emetic |
|
Q0187 |
Factor VIIa (coagulation factor, recombinant) per 1.2 mg |
|
Q2002 |
Injection, Elliot’s B solution, per ml |
|
Q2003 |
Injection, aprotinin, 10,000 kiu |
|
Q2004 |
Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml |
|
Q2005 |
Injection, corticorelin ovine triflutate, per dose |
|
Q2006 |
Injection, digoxin immune fab (ovine), per vial |
|
Q2007 |
Injection, ethanolamine oleate, 100 mg |
|
Q2008 |
Injection, fomepizole, 1.5 mg |
|
Q2009 |
Injection, fosphenytoin, 50 mg |
|
Q2010 |
Injection, glatiramer acetate, per dose |
|
Q2011 |
Injection, hemin, per 1 mg |
|
Q2012 |
Injection, pegademase bovine, 25 IU |
|
Q2013 |
Injection, pentastarch, 10% solution, per 100 ml |
|
Q2014 |
Injection, sermorelin acetate, 0.5 mg |
|
Q2015 |
Injection, somatrem, 5 mg |
|
Q2016 |
Injection, somatropin, 1 mg |
|
Q2017 |
Injection, teniposide, 50 mg |
|
Q2018 |
Injection, urofollitropin, 75 IU |
|
Q2019 |
Injection, basiliximab, 20 mg |
|
Q2020 |
Injection, histrelin acetate, 10 mg |
|
Q2021 |
Injection, lepirudin, 50 mg |
|
Q2022 |
Von Willebrand factor complex, human, per IU |
|
Q3002 |
Supply of radiopharmaceutical diagnostic imaging agent, gallium Ga 67, per mCi |
|
Q3003 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m bicisate, per unit dose
|
|
Q3004 |
Supply of radiopharmaceutical diagnostic imaging agent, xenon XE 133, per 10 mCi |
|
Q3005 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m mertiatide, per vial |
|
Q3006 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m D-gluco-heptonate complex |
|
Q3007 |
Supply of radiopharmaceutical diagnostic imaging agent, sodium phosphate P 32, per mCi |
|
Q3008 |
Supply of radiopharmaceutical diagnostic imaging agent, indium IN 111 pentetreotide, per 3 mCi |
|
Q3009 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m oxidronate, per mCi |
|
Q3010 |
Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m labeled red blood cell, per mCi
|
|
Q3011 |
Supply of radiopharmaceutical diagnostic imaging agent, chromic phosphate P 32 suspension, per mCi |
The specific devices shown below should be coded using the corresponding C-codes only. The C-codes in the left column (see below) are temporary and should only be used from August 1, 2000 to
September 30, 2000. The C-codes in the right column (see below) are to be used effective
October 1, 2000.
We will issue a new Outpatient Code Editor (OCE) and program memorandum to our Fiscal Intermediaries for changes that will be effective on October 1, 2000. The subsequent program memorandum will include a list of new technology services, and approved drugs, devices, and biologicals eligible for transitional pass-through payments. Therefore, Fiscal Intermediaries (FIs) should take no action at this time with respect to the codes that will be effective October 1, 2000.
The information contained within this program memorandum is for billing purposes only. The OCE will not be updated to reflect changes below until we issue an OCE update for October 2000.
|
HCPCS Code (Aug-Sep) |
LONG DESCRIPTORS |
HCPCS Code (as of 10/01/00) |
|
C1005 |
Intraocular lens, STAAR Elastic Ultraviolet-Absorbing Silicone Posterior Chamber Intraocular Lens with Toric Optic Model AA-4203T, Model AA-4203TF, Model AA-4203TL |
C3851 |
|
C1007 |
Prosthesis, penile, Mentor Alpha I Inflatable Penile Prosthesis |
C3500 |
|
C1025 |
Fast-Cath, Swartz, SAFL, CSTA, SEPT, RAMP Guiding Introducer
|
C1004 |
|
C1026 |
Catheter, ablation, Gynecare Thermachoice II Catheter |
C1056 |
|
C1027 |
Stent, coronary, Radius 20mm Self Expanding Stent with Over the Wire Delivery System |
C5046 |
|
C1028 |
Single use device for treatment of female stress urinary incontinence, Tension-Free Vaginal Tape Single Use Device
|
C1370 |
|
C1028 |
Sling fixation system for treatment of stress urinary incontinence, Female In-Fast Sling Fixation System with Electric Inserter with Sling Material, Female In-Fast Sling Fixation System with Electric Inserter without Sling Material
|
C6050 |
|
C1028 |
Sling fixation system for treatment of stress urinary incontinence, Male Straight-In Fixation System with Electric Inserter with Sling Material and Disposable Pressure Sensor, Male Straight-In Fixation System with Electric Inserter without Sling Material an |