|
J0120 |
 |
Injection, tetracycline, up to 250 mg
| short | Tetracyclin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0121 |
|
Injection, omadacycline, 1 mg
| short | Inj., omadacycline, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J0122 |
|
Injection, eravacycline, 1 mg
| short | Inj., eravacycline, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J0129 |
|
Injection, abatacept, 10 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)
| short | Abatacept injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0130 |
|
Injection abciximab, 10 mg
| short | Abciximab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0131 |
|
Injection, acetaminophen, 10 mg
| short | Acetaminophen injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0132 |
|
Injection, acetylcysteine, 100 mg
| short | Acetylcysteine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0133 |
|
Injection, acyclovir, 5 mg
| short | Acyclovir injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 3600.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J0135 |
|
Injection, adalimumab, 20 mg
| short | Adalimumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0150 |
|
Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)
| short | Injection adenosine 6 mg |
|
|
|
J0151 |
|
Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)
| short | Inj adenosine diag 1mg |
|
|
|
J0153 |
|
Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)
| short | Adenosine inj 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 180.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 180.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0171 |
|
Injection, adrenalin, epinephrine, 0.1 mg
| short | Adrenalin epinephrine inject |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0178 |
|
Injection, aflibercept, 1 mg
| short | Aflibercept injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0179 |
|
Injection, brolucizumab-dbll, 1 mg
| short | Inj, brolucizumab-dbll, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J0180 |
|
Injection, agalsidase beta, 1 mg
| short | Agalsidase beta injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 140.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 140.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0185 |
|
Injection, aprepitant, 1 mg
| short | Inj., aprepitant, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 130.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 130.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J0190 |
|
Injection, biperiden lactate, per 5 mg
| short | Inj biperiden lactate/5 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0200 |
|
Injection, alatrofloxacin mesylate, 100 mg
| short | Alatrofloxacin mesylate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0202 |
|
Injection, alemtuzumab, 1 mg
| short | Injection, alemtuzumab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0205 |
|
Injection, alglucerase, per 10 units
| short | Alglucerase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0207 |
|
Injection, amifostine, 500 mg
| short | Amifostine |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0210 |
|
Injection, methyldopate hcl, up to 250 mg
| short | Methyldopate hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0215 |
|
Injection, alefacept, 0.5 mg
| short | Alefacept |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 30.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0220 |
|
Injection, alglucosidase alfa, 10 mg, not otherwise specified
| short | Alglucosidase alfa injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0221 |
|
Injection, alglucosidase alfa, (lumizyme), 10 mg
| short | Lumizyme injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 250.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0222 |
|
Injection, patisiran, 0.1 mg
| short | Inj., patisiran, 0.1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J0256 |
|
Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg
| short | Alpha 1 proteinase inhibitor |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1600.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 1600.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0257 |
|
Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg
| short | Glassia injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1400.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 1400.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0270 |
|
Injection, alprostadil, 1.25 mcg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
| short | Alprostadil for injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 32.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 32.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0275 |
|
Alprostadil urethral suppository (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
| short | Alprostadil urethral suppos |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0278 |
|
Injection, amikacin sulfate, 100 mg
| short | Amikacin sulfate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0280 |
|
Injection, aminophyllin, up to 250 mg
| short | Aminophyllin 250 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 7.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0282 |
|
Injection, amiodarone hydrochloride, 30 mg
| short | Amiodarone hcl |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 70.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0285 |
|
Injection, amphotericin b, 50 mg
| short | Amphotericin b |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J0287 |
|
Injection, amphotericin b lipid complex, 10 mg
| short | Amphotericin b lipid complex |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 50.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J0288 |
|
Injection, amphotericin b cholesteryl sulfate complex, 10 mg
| short | Ampho b cholesteryl sulfate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0289 |
|
Injection, amphotericin b liposome, 10 mg
| short | Amphotericin b liposome inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 50.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 115.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 150.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J0290 |
|
Injection, ampicillin sodium, 500 mg
| short | Ampicillin 500 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 24.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 24.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0291 |
|
Injection, plazomicin, 5 mg
| short | Inj., plazomicin, 5 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 500.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 500.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J0295 |
|
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm
| short | Ampicillin sulbactam 1.5 gm |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0300 |
|
Injection, amobarbital, up to 125 mg
| short | Amobarbital 125 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0330 |
|
Injection, succinylcholine chloride, up to 20 mg
| short | Succinycholine chloride inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0348 |
|
Injection, anidulafungin, 1 mg
| short | Anidulafungin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0350 |
|
Injection, anistreplase, per 30 units
| short | Injection anistreplase 30 u |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0360 |
|
Injection, hydralazine hcl, up to 20 mg
| short | Hydralazine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0364 |
|
Injection, apomorphine hydrochloride, 1 mg
| short | Apomorphine hydrochloride |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0365 |
|
Injection, aprotonin, 10,000 kiu
| short | Aprotonin, 10,000 kiu |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0380 |
|
Injection, metaraminol bitartrate, per 10 mg
| short | Inj metaraminol bitartrate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0390 |
|
Injection, chloroquine hydrochloride, up to 250 mg
| short | Chloroquine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0395 |
|
Injection, arbutamine hcl, 1 mg
| short | Arbutamine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0400 |
|
Injection, aripiprazole, intramuscular, 0.25 mg
| short | Aripiprazole injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 39.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0401 |
|
Injection, aripiprazole, extended release, 1 mg
| short | Inj aripiprazole ext rel 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0456 |
|
Injection, azithromycin, 500 mg
| short | Azithromycin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0461 |
|
Injection, atropine sulfate, 0.01 mg
| short | Atropine sulfate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 800.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0470 |
|
Injection, dimercaprol, per 100 mg
| short | Dimecaprol injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0475 |
|
Injection, baclofen, 10 mg
| short | Baclofen 10 mg injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0476 |
|
Injection, baclofen, 50 mcg for intrathecal trial
| short | Baclofen intrathecal trial |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0480 |
|
Injection, basiliximab, 20 mg
| short | Basiliximab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0485 |
|
Injection, belatacept, 1 mg
| short | Belatacept injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1500.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1500.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0490 |
|
Injection, belimumab, 10 mg
| short | Belimumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0500 |
|
Injection, dicyclomine hcl, up to 20 mg
| short | Dicyclomine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0515 |
|
Injection, benztropine mesylate, per 1 mg
| short | Inj benztropine mesylate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0517 |
|
Injection, benralizumab, 1 mg
| short | Inj., benralizumab, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 30.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 30.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J0520 |
|
Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg
| short | Bethanechol chloride inject |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0558 |
|
Injection, penicillin g benzathine and penicillin g procaine, 100,000 units
| short | Peng benzathine/procaine inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 24.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 24.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0561 |
|
Injection, penicillin g benzathine, 100,000 units
| short | Penicillin g benzathine inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 24.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 24.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0565 |
|
Injection, bezlotoxumab, 10 mg
| short | Inj, bezlotoxumab, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0567 |
|
Injection, cerliponase alfa, 1 mg
| short | Inj., cerliponase alfa 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J0570 |
|
Buprenorphine implant, 74.2 mg
| short | Buprenorphine implant 74.2mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0571 |
|
Buprenorphine, oral, 1 mg
| short | Buprenorphine oral 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0572 |
|
Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine
| short | Bupren/nal up to 3mg bupreno |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0573 |
|
Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine
| short | Bupren/nal 3.1 to 6mg bupren |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0574 |
|
Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine
| short | Bupren/nal 6.1 to 10mg bupre |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0575 |
|
Buprenorphine/naloxone, oral, greater than 10 mg buprenorphine
| short | Bupren/nal over 10mg bupreno |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Oral Medication; Not Payable | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0583 |
|
Injection, bivalirudin, 1 mg
| short | Bivalirudin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 250.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 1250.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0584 |
|
Injection, burosumab-twza 1 mg
| short | Injection, burosumab-twza 1m |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 90.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 90.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J0585 |
|
Injection, onabotulinumtoxina, 1 unit
| short | Injection,onabotulinumtoxina |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0586 |
|
Injection, abobotulinumtoxina, 5 units
| short | Abobotulinumtoxina |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0587 |
|
Injection, rimabotulinumtoxinb, 100 units
| short | Inj, rimabotulinumtoxinb |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0588 |
|
Injection, incobotulinumtoxin a, 1 unit
| short | Incobotulinumtoxin a |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0592 |
|
Injection, buprenorphine hydrochloride, 0.1 mg
| short | Buprenorphine hydrochloride |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0593 |
|
Injection, lanadelumab-flyo, 1 mg (code may be used for medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)
| short | Inj., lanadelumab-flyo, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J0594 |
|
injection, busulfan, 1 mg
| short | Busulfan injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 320.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 320.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0595 |
|
Injection, butorphanol tartrate, 1 mg
| short | Butorphanol tartrate 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0596 |
|
Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units
| short | Injection, ruconest |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 840.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 840.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0597 |
|
Injection, c-1 esterase inhibitor (human), berinert, 10 units
| short | C-1 esterase, berinert |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 250.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 250.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0598 |
|
Injection, c-1 esterase inhibitor (human), cinryze, 10 units
| short | C-1 esterase, cinryze |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0599 |
|
Injection, c-1 esterase inhibitor (human), (haegarda), 10 units
| short | Inj., haegarda 10 units |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 900.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 900.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J0600 |
|
Injection, edetate calcium disodium, up to 1000 mg
| short | Edetate calcium disodium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0604 |
|
Cinacalcet, oral, 1 mg, (for esrd on dialysis)
| short | Cinacalcet, esrd on dialysis |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J0606 |
|
Injection, etelcalcetide, 0.1 mg
| short | Inj, etelcalcetide, 0.1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0610 |
|
Injection, calcium gluconate, per 10 ml
| short | Calcium gluconate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0620 |
|
Injection, calcium glycerophosphate and calcium lactate, per 10 ml
| short | Calcium glycer & lact/10 ml |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0630 |
|
Injection, calcitonin salmon, up to 400 units
| short | Calcitonin salmon injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0636 |
|
Injection, calcitriol, 0.1 mcg
| short | Inj calcitriol per 0.1 mcg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0637 |
|
Injection, caspofungin acetate, 5 mg
| short | Caspofungin acetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0638 |
|
Injection, canakinumab, 1 mg
| short | Canakinumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0640 |
|
Injection, leucovorin calcium, per 50 mg
| short | Leucovorin calcium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 24.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 24.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0641 |
|
Injection, levoleucovorin, not otherwise specified, 0.5 mg
| short | Inj levoleucovorin nos 0.5mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1200.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 1200.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0642 |
|
Injection, levoleucovorin (khapzory), 0.5 mg
| short | Injection, khapzory, 0.5 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J0670 |
|
Injection, mepivacaine hydrochloride, per 10 ml
| short | Inj mepivacaine hcl/10 ml |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0690 |
|
Injection, cefazolin sodium, 500 mg
| short | Cefazolin sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0692 |
|
Injection, cefepime hydrochloride, 500 mg
| short | Cefepime hcl for injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0694 |
|
Injection, cefoxitin sodium, 1 gm
| short | Cefoxitin sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0695 |
|
Injection, ceftolozane 50 mg and tazobactam 25 mg
| short | Inj ceftolozane tazobactam |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0696 |
|
Injection, ceftriaxone sodium, per 250 mg
| short | Ceftriaxone sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0697 |
|
Injection, sterile cefuroxime sodium, per 750 mg
| short | Sterile cefuroxime injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0698 |
|
Injection, cefotaxime sodium, per gm
| short | Cefotaxime sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0702 |
|
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg
| short | Betamethasone acet&sod phosp |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 18.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0706 |
|
Injection, caffeine citrate, 5 mg
| short | Caffeine citrate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0710 |
|
Injection, cephapirin sodium, up to 1 gm
| short | Cephapirin sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0712 |
|
Injection, ceftaroline fosamil, 10 mg
| short | Ceftaroline fosamil inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 180.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0713 |
|
Injection, ceftazidime, per 500 mg
| short | Inj ceftazidime per 500 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0714 |
|
Injection, ceftazidime and avibactam, 0.5 g/0.125 g
| short | Ceftazidime and avibactam |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0715 |
|
Injection, ceftizoxime sodium, per 500 mg
| short | Ceftizoxime sodium / 500 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0716 |
|
Injection, centruroides immune f(ab)2, up to 120 milligrams
| short | Centruroides immune f(ab) |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 1 Line Edit | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0717 |
|
Injection, certolizumab pegol, 1 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)
| short | Certolizumab pegol inj 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0720 |
|
Injection, chloramphenicol sodium succinate, up to 1 gm
| short | Chloramphenicol sodium injec |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0725 |
|
Injection, chorionic gonadotropin, per 1,000 usp units
| short | Chorionic gonadotropin/1000u |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0735 |
|
Injection, clonidine hydrochloride, 1 mg
| short | Clonidine hydrochloride |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0740 |
|
Injection, cidofovir, 375 mg
| short | Cidofovir injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0743 |
|
Injection, cilastatin sodium; imipenem, per 250 mg
| short | Cilastatin sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0744 |
|
Injection, ciprofloxacin for intravenous infusion, 200 mg
| short | Ciprofloxacin iv |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0745 |
|
Injection, codeine phosphate, per 30 mg
| short | Inj codeine phosphate /30 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0760 |
|
Injection, colchicine, per 1 mg
| short | Colchicine injection |
|
|
|
J0770 |
|
Injection, colistimethate sodium, up to 150 mg
| short | Colistimethate sodium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0775 |
|
Injection, collagenase, clostridium histolyticum, 0.01 mg
| short | Collagenase, clost hist inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 180.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 180.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0780 |
|
Injection, prochlorperazine, up to 10 mg
| short | Prochlorperazine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0795 |
|
Injection, corticorelin ovine triflutate, 1 microgram
| short | Corticorelin ovine triflutal |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0800 |
|
Injection, corticotropin, up to 40 units
| short | Corticotropin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0833 |
|
Injection, cosyntropin, not otherwise specified, 0.25 mg
| short | Cosyntropin injection nos |
|
|
|
J0834 |
|
Injection, cosyntropin, 0.25 mg
| short | Inj., cosyntropin, 0.25 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0840 |
|
Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram
| short | Crotalidae poly immune fab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 18.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0841 |
|
Injection, crotalidae immune f(ab')2 (equine), 120 mg
| short | Inj crotalidae im f(ab')2 eq |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 24.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment |
|
|
|
|
J0850 |
|
Injection, cytomegalovirus immune globulin intravenous (human), per vial
| short | Cytomegalovirus imm iv /vial |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 9.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 9.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0875 |
|
Injection, dalbavancin, 5 mg
| short | Injection, dalbavancin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0878 |
|
Injection, daptomycin, 1 mg
| short | Daptomycin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1500.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 1500.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0881 |
|
Injection, darbepoetin alfa, 1 microgram (non-esrd use)
| short | Darbepoetin alfa, non-esrd |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 500.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 500.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0882 |
|
Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)
| short | Darbepoetin alfa, esrd use |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0883 |
|
Injection, argatroban, 1 mg (for non-esrd use)
| short | Argatroban nonesrd use 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1125.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1250.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0884 |
|
Injection, argatroban, 1 mg (for esrd on dialysis)
| short | Argatroban esrd dialysis 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1125.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1250.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0885 |
|
Injection, epoetin alfa, (for non-esrd use), 1000 units
| short | Epoetin alfa, non-esrd |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0886 |
|
Injection, epoetin alfa, 1000 units (for esrd on dialysis)
| short | Epoetin alfa 1000 units esrd |
|
|
|
J0887 |
|
Injection, epoetin beta, 1 microgram, (for esrd on dialysis)
| short | Epoetin beta esrd use |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 360.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 360.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0888 |
|
Injection, epoetin beta, 1 microgram, (for non esrd use)
| short | Epoetin beta non esrd |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 360.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 360.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0890 |
|
Injection, peginesatide, 0.1 mg (for esrd on dialysis)
| short | Peginesatide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J0894 |
|
Injection, decitabine, 1 mg
| short | Decitabine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0895 |
|
Injection, deferoxamine mesylate, 500 mg
| short | Deferoxamine mesylate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 212.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J0897 |
|
Injection, denosumab, 1 mg
| short | Denosumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J0900 |
|
Injection, testosterone enanthate and estradiol valerate, up to 1 cc
| short | Testosterone enanthate inj |
|
|
|
J0945 |
|
Injection, brompheniramine maleate, per 10 mg
| short | Brompheniramine maleate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1000 |
|
Injection, depo-estradiol cypionate, up to 5 mg
| short | Depo-estradiol cypionate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1020 |
|
Injection, methylprednisolone acetate, 20 mg
| short | Methylprednisolone 20 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1030 |
|
Injection, methylprednisolone acetate, 40 mg
| short | Methylprednisolone 40 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1040 |
|
Injection, methylprednisolone acetate, 80 mg
| short | Methylprednisolone 80 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1050 |
|
Injection, medroxyprogesterone acetate, 1 mg
| short | Medroxyprogesterone acetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1000.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1000.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1060 |
|
Injection, testosterone cypionate and estradiol cypionate, up to 1 ml
| short | Testosterone cypionate 1 ml |
|
|
|
J1070 |
|
Injection, testosterone cypionate, up to 100 mg
| short | Testosterone cypionat 100 mg |
|
|
|
J1071 |
|
Injection, testosterone cypionate, 1 mg
| short | Inj testosterone cypionate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1080 |
|
Injection, testosterone cypionate, 1 cc, 200 mg
| short | Testosterone cypionat 200 mg |
|
|
|
J1094 |
|
Injection, dexamethasone acetate, 1 mg
| short | Inj dexamethasone acetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1095 |
|
Injection, dexamethasone 9 percent, intraocular, 1 microgram
| short | Injection, dexamethasone 9% |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 517.0 | 1 Line Edit | Prescribing Information | | OPH | 517.0 | 1 Line Edit | Prescribing Information |
|
|
|
|
J1096 |
|
Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
| short | Dexametha opth insert 0.1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J1097 |
|
Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml
| short | Phenylep ketorolac opth soln |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J1100 |
|
Injection, dexamethasone sodium phosphate, 1 mg
| short | Dexamethasone sodium phos |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1110 |
|
Injection, dihydroergotamine mesylate, per 1 mg
| short | Inj dihydroergotamine mesylt |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1120 |
|
Injection, acetazolamide sodium, up to 500 mg
| short | Acetazolamid sodium injectio |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1130 |
|
Injection, diclofenac sodium, 0.5 mg
| short | Inj diclofenac sodium 0.5mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1160 |
|
Injection, digoxin, up to 0.5 mg
| short | Digoxin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1162 |
|
Injection, digoxin immune fab (ovine), per vial
| short | Digoxin immune fab (ovine) |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1165 |
|
Injection, phenytoin sodium, per 50 mg
| short | Phenytoin sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1170 |
|
Injection, hydromorphone, up to 4 mg
| short | Hydromorphone injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 350.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 2500.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1180 |
|
Injection, dyphylline, up to 500 mg
| short | Dyphylline injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1190 |
|
Injection, dexrazoxane hydrochloride, per 250 mg
| short | Dexrazoxane hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1200 |
|
Injection, diphenhydramine hcl, up to 50 mg
| short | Diphenhydramine hcl injectio |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1205 |
|
Injection, chlorothiazide sodium, per 500 mg
| short | Chlorothiazide sodium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1212 |
|
Injection, dmso, dimethyl sulfoxide, 50%, 50 ml
| short | Dimethyl sulfoxide 50% 50 ml |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1230 |
|
Injection, methadone hcl, up to 10 mg
| short | Methadone injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1240 |
|
Injection, dimenhydrinate, up to 50 mg
| short | Dimenhydrinate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1245 |
|
Injection, dipyridamole, per 10 mg
| short | Dipyridamole injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1250 |
|
Injection, dobutamine hydrochloride, per 250 mg
| short | Inj dobutamine hcl/250 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 60.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1260 |
|
Injection, dolasetron mesylate, 10 mg
| short | Dolasetron mesylate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1265 |
|
Injection, dopamine hcl, 40 mg
| short | Dopamine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 230.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1267 |
|
Injection, doripenem, 10 mg
| short | Doripenem injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1270 |
|
Injection, doxercalciferol, 1 mcg
| short | Injection, doxercalciferol |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1290 |
|
Injection, ecallantide, 1 mg
| short | Ecallantide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1300 |
|
Injection, eculizumab, 10 mg
| short | Eculizumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1301 |
|
Injection, edaravone, 1 mg
| short | Injection, edaravone, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J1303 |
|
Injection, ravulizumab-cwvz, 10 mg
| short | Inj., ravulizumab-cwvz 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J1320 |
|
Injection, amitriptyline hcl, up to 20 mg
| short | Amitriptyline injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1322 |
|
Injection, elosulfase alfa, 1 mg
| short | Elosulfase alfa, injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1324 |
|
Injection, enfuvirtide, 1 mg
| short | Enfuvirtide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 108.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1325 |
|
Injection, epoprostenol, 0.5 mg
| short | Epoprostenol injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 18.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 810.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1327 |
|
Injection, eptifibatide, 5 mg
| short | Eptifibatide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 99.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1330 |
|
Injection, ergonovine maleate, up to 0.2 mg
| short | Ergonovine maleate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1335 |
|
Injection, ertapenem sodium, 500 mg
| short | Ertapenem injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1364 |
|
Injection, erythromycin lactobionate, per 500 mg
| short | Erythro lactobionate /500 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1380 |
|
Injection, estradiol valerate, up to 10 mg
| short | Estradiol valerate 10 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1410 |
|
Injection, estrogen conjugated, per 25 mg
| short | Inj estrogen conjugate 25 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1428 |
|
Injection, eteplirsen, 10 mg
| short | Inj, eteplirsen, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 450.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 450.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1430 |
|
Injection, ethanolamine oleate, 100 mg
| short | Ethanolamine oleate 100 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1435 |
|
Injection, estrone, per 1 mg
| short | Injection estrone per 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1436 |
|
Injection, etidronate disodium, per 300 mg
| short | Etidronate disodium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
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)
| short | Etanercept injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1439 |
|
Injection, ferric carboxymaltose, 1 mg
| short | Inj ferric carboxymaltos 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 750.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 750.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1442 |
|
Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram
| short | Inj filgrastim excl biosimil |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1500.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 1500.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1443 |
|
Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron
| short | Inj ferric pyrophosphate cit |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 272.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1444 |
|
Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron
| short | Fe pyro cit pow 0.1 mg iron |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 272.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 272.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J1446 |
|
Injection, tbo-filgrastim, 5 micrograms
| short | Inj, tbo-filgrastim, 5 mcg |
|
|
|
J1447 |
|
Injection, tbo-filgrastim, 1 microgram
| short | Inj tbo filgrastim 1 microg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 960.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 960.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1450 |
|
Injection fluconazole, 200 mg
| short | Fluconazole |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1451 |
|
Injection, fomepizole, 15 mg
| short | Fomepizole, 15 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1452 |
|
Injection, fomivirsen sodium, intraocular, 1.65 mg
| short | Intraocular fomivirsen na |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1453 |
|
Injection, fosaprepitant, 1 mg
| short | Fosaprepitant injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1454 |
|
Injection, fosnetupitant 235 mg and palonosetron 0.25 mg
| short | Inj fosnetupitant, palonoset |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J1455 |
|
Injection, foscarnet sodium, per 1000 mg
| short | Foscarnet sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 18.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 18.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 90.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1457 |
|
Injection, gallium nitrate, 1 mg
| short | Gallium nitrate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1458 |
|
Injection, galsulfase, 1 mg
| short | Galsulfase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1459 |
|
Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg
| short | Inj ivig privigen 500 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J1460 |
|
Injection, gamma globulin, intramuscular, 1 cc
| short | Gamma globulin 1 cc inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 10.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1555 |
|
Injection, immune globulin (cuvitru), 100 mg
| short | Inj cuvitru, 100 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 480.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 480.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 1500.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J1556 |
|
Injection, immune globulin (bivigam), 500 mg
| short | Inj, imm glob bivigam, 500mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J1557 |
|
Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg
| short | Gammaplex injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J1559 |
|
Injection, immune globulin (hizentra), 100 mg
| short | Hizentra injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 1500.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1560 |
|
Injection, gamma globulin, intramuscular, over 10 cc
| short | Gamma globulin > 10 cc inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1561 |
|
Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg
| short | Gamunex-c/gammaked |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1562 |
|
Injection, immune globulin (vivaglobin), 100 mg
| short | Vivaglobin, inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1566 |
|
Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg
| short | Immune globulin, powder |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J1568 |
|
Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg
| short | Octagam injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J1569 |
|
Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg
| short | Gammagard liquid injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1570 |
|
Injection, ganciclovir sodium, 500 mg
| short | Ganciclovir sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 18.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1571 |
|
Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml
| short | Hepagam b im injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1572 |
|
Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg
| short | Flebogamma injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J1573 |
|
Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml
| short | Hepagam b intravenous, inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 130.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 130.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1575 |
|
Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin
| short | Hyqvia 100mg immuneglobulin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 650.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 650.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 900.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J1580 |
|
Injection, garamycin, gentamicin, up to 80 mg
| short | Garamycin gentamicin inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 9.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 9.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1590 |
|
Injection, gatifloxacin, 10 mg
| short | Gatifloxacin injection |
|
|
|
J1595 |
|
Injection, glatiramer acetate, 20 mg
| short | Injection glatiramer acetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1599 |
|
Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg
| short | Ivig non-lyophilized, nos |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 300.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J1600 |
|
Injection, gold sodium thiomalate, up to 50 mg
| short | Gold sodium thiomaleate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1602 |
|
Injection, golimumab, 1 mg, for intravenous use
| short | Golimumab for iv use 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1610 |
|
Injection, glucagon hydrochloride, per 1 mg
| short | Glucagon hydrochloride/1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1620 |
|
Injection, gonadorelin hydrochloride, per 100 mcg
| short | Gonadorelin hydroch/ 100 mcg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1626 |
|
Injection, granisetron hydrochloride, 100 mcg
| short | Granisetron hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1627 |
|
Injection, granisetron, extended-release, 0.1 mg
| short | Inj, granisetron, xr, 0.1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1628 |
|
Injection, guselkumab, 1 mg
| short | Inj., guselkumab, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J1630 |
|
Injection, haloperidol, up to 5 mg
| short | Haloperidol injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 7.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1631 |
|
Injection, haloperidol decanoate, per 50 mg
| short | Haloperidol decanoate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 9.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 9.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1640 |
|
Injection, hemin, 1 mg
| short | Hemin, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 672.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 672.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1642 |
|
Injection, heparin sodium, (heparin lock flush), per 10 units
| short | Inj heparin sodium per 10 u |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1644 |
|
Injection, heparin sodium, per 1000 units
| short | Inj heparin sodium per 1000u |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 40.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1645 |
|
Injection, dalteparin sodium, per 2500 iu
| short | Dalteparin sodium |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1650 |
|
Injection, enoxaparin sodium, 10 mg
| short | Inj enoxaparin sodium |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 30.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 30.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1652 |
|
Injection, fondaparinux sodium, 0.5 mg
| short | Fondaparinux sodium |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1655 |
|
Injection, tinzaparin sodium, 1000 iu
| short | Tinzaparin sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1670 |
|
Injection, tetanus immune globulin, human, up to 250 units
| short | Tetanus immune globulin inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1675 |
|
Injection, histrelin acetate, 10 micrograms
| short | Histrelin acetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1700 |
|
Injection, hydrocortisone acetate, up to 25 mg
| short | Hydrocortisone acetate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1710 |
|
Injection, hydrocortisone sodium phosphate, up to 50 mg
| short | Hydrocortisone sodium ph inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1720 |
|
Injection, hydrocortisone sodium succinate, up to 100 mg
| short | Hydrocortisone sodium succ i |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1725 |
|
Injection, hydroxyprogesterone caproate, 1 mg
| short | Hydroxyprogesterone caproate |
|
|
|
J1726 |
|
Injection, hydroxyprogesterone caproate, (makena), 10 mg
| short | Makena, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 28.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 28.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1729 |
|
Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg
| short | Inj hydroxyprogst capoat nos |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1730 |
|
Injection, diazoxide, up to 300 mg
| short | Diazoxide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1740 |
|
Injection, ibandronate sodium, 1 mg
| short | Ibandronate sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1741 |
|
Injection, ibuprofen, 100 mg
| short | Ibuprofen injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 32.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1742 |
|
Injection, ibutilide fumarate, 1 mg
| short | Ibutilide fumarate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1743 |
|
Injection, idursulfase, 1 mg
| short | Idursulfase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 66.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 66.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1744 |
|
Injection, icatibant, 1 mg
| short | Icatibant injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 30.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 90.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1745 |
|
Injection, infliximab, excludes biosimilar, 10 mg
| short | Infliximab not biosimil 10mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1746 |
|
Injection, ibalizumab-uiyk, 10 mg
| short | Inj., ibalizumab-uiyk, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J1750 |
|
Injection, iron dextran, 50 mg
| short | Inj iron dextran |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 45.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 45.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1756 |
|
Injection, iron sucrose, 1 mg
| short | Iron sucrose injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 500.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 500.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1786 |
|
Injection, imiglucerase, 10 units
| short | Imuglucerase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 680.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 680.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1790 |
|
Injection, droperidol, up to 5 mg
| short | Droperidol injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1800 |
|
Injection, propranolol hcl, up to 1 mg
| short | Propranolol injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1810 |
|
Injection, droperidol and fentanyl citrate, up to 2 ml ampule
| short | Droperidol/fentanyl inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1815 |
|
Injection, insulin, per 5 units
| short | Insulin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1817 |
|
Insulin for administration through dme (i.e., insulin pump) per 50 units
| short | Insulin for insulin pump use |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 270.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J1826 |
|
Injection, interferon beta-1a, 30 mcg
| short | Interferon beta-1a inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
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)
| short | Interferon beta-1b / .25 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1833 |
|
Injection, isavuconazonium, 1 mg
| short | Injection, isavuconazonium |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 372.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1116.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1835 |
|
Injection, itraconazole, 50 mg
| short | Itraconazole injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1840 |
|
Injection, kanamycin sulfate, up to 500 mg
| short | Kanamycin sulfate 500 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1850 |
|
Injection, kanamycin sulfate, up to 75 mg
| short | Kanamycin sulfate 75 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 14.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1885 |
|
Injection, ketorolac tromethamine, per 15 mg
| short | Ketorolac tromethamine inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1890 |
|
Injection, cephalothin sodium, up to 1 gram
| short | Cephalothin sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1930 |
|
Injection, lanreotide, 1 mg
| short | Lanreotide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1931 |
|
Injection, laronidase, 0.1 mg
| short | Laronidase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 377.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 609.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1940 |
|
Injection, furosemide, up to 20 mg
| short | Furosemide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1942 |
|
Injection, aripiprazole lauroxil, 1 mg
| short | Aripiprazole lauroxil 1mg |
|
|
|
J1943 |
|
Injection, aripiprazole lauroxil, (aristada initio), 1 mg
| short | Inj., aristada initio, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 675.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 675.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J1944 |
|
Injection, aripiprazole lauroxil, (aristada), 1 mg
| short | Aripirazole lauroxil 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J1945 |
|
Injection, lepirudin, 50 mg
| short | Lepirudin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1950 |
|
Injection, leuprolide acetate (for depot suspension), per 3.75 mg
| short | Leuprolide acetate /3.75 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1953 |
|
Injection, levetiracetam, 10 mg
| short | Levetiracetam injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1955 |
|
Injection, levocarnitine, per 1 gm
| short | Inj levocarnitine per 1 gm |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 11.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 11.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1956 |
|
Injection, levofloxacin, 250 mg
| short | Levofloxacin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1960 |
|
Injection, levorphanol tartrate, up to 2 mg
| short | Levorphanol tartrate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J1980 |
|
Injection, hyoscyamine sulfate, up to 0.25 mg
| short | Hyoscyamine sulfate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J1990 |
|
Injection, chlordiazepoxide hcl, up to 100 mg
| short | Chlordiazepoxide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2001 |
|
Injection, lidocaine hcl for intravenous infusion, 10 mg
| short | Lidocaine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2010 |
|
Injection, lincomycin hcl, up to 300 mg
| short | Lincomycin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2020 |
|
Injection, linezolid, 200 mg
| short | Linezolid injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2060 |
|
Injection, lorazepam, 2 mg
| short | Lorazepam injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2062 |
|
Loxapine for inhalation, 1 mg
| short | Loxapine for inhalation 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J2150 |
|
Injection, mannitol, 25% in 50 ml
| short | Mannitol injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2170 |
|
Injection, mecasermin, 1 mg
| short | Mecasermin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2175 |
|
Injection, meperidine hydrochloride, per 100 mg
| short | Meperidine hydrochl /100 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J2180 |
|
Injection, meperidine and promethazine hcl, up to 50 mg
| short | Meperidine/promethazine inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2182 |
|
Injection, mepolizumab, 1 mg
| short | Injection, mepolizumab, 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2185 |
|
Injection, meropenem, 100 mg
| short | Meropenem |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2186 |
|
Injection, meropenem and vaborbactam, 10mg/10mg (20mg)
| short | Inj., meropenem, vaborbactam |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J2210 |
|
Injection, methylergonovine maleate, up to 0.2 mg
| short | Methylergonovin maleate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2212 |
|
Injection, methylnaltrexone, 0.1 mg
| short | Methylnaltrexone injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2248 |
|
Injection, micafungin sodium, 1 mg
| short | Micafungin sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2250 |
|
Injection, midazolam hydrochloride, per 1 mg
| short | Inj midazolam hydrochloride |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 22.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2260 |
|
Injection, milrinone lactate, 5 mg
| short | Inj milrinone lactate / 5 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 252.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J2265 |
|
Injection, minocycline hydrochloride, 1 mg
| short | Minocycline hydrochloride |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2270 |
|
Injection, morphine sulfate, up to 10 mg
| short | Morphine sulfate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 9.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 320.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J2271 |
|
Injection, morphine sulfate, 100mg
| short | Morphine so4 injection 100mg |
|
|
|
J2274 |
|
Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg
| short | Inj morphine pf epid ithc |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 250.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2275 |
|
Injection, morphine sulfate (preservative-free sterile solution), per 10 mg
| short | Morphine sulfate injection |
|
|
|
J2278 |
|
Injection, ziconotide, 1 microgram
| short | Ziconotide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1000.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 1000.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 999.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J2280 |
|
Injection, moxifloxacin, 100 mg
| short | Inj, moxifloxacin 100 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2300 |
|
Injection, nalbuphine hydrochloride, per 10 mg
| short | Inj nalbuphine hydrochloride |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2310 |
|
Injection, naloxone hydrochloride, per 1 mg
| short | Inj naloxone hydrochloride |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2315 |
|
Injection, naltrexone, depot form, 1 mg
| short | Naltrexone, depot form |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 380.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 380.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2320 |
|
Injection, nandrolone decanoate, up to 50 mg
| short | Nandrolone decanoate 50 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2323 |
|
Injection, natalizumab, 1 mg
| short | Natalizumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2325 |
|
Injection, nesiritide, 0.1 mg
| short | Nesiritide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 34.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2326 |
|
Injection, nusinersen, 0.1 mg
| short | Inj, nusinersen, 0.1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2350 |
|
Injection, ocrelizumab, 1 mg
| short | Injection, ocrelizumab, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2353 |
|
Injection, octreotide, depot form for intramuscular injection, 1 mg
| short | Octreotide injection, depot |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2354 |
|
Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg
| short | Octreotide inj, non-depot |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J2355 |
|
Injection, oprelvekin, 5 mg
| short | Oprelvekin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2357 |
|
Injection, omalizumab, 5 mg
| short | Omalizumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 90.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 90.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2358 |
|
Injection, olanzapine, long-acting, 1 mg
| short | Olanzapine long-acting inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 405.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 405.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2360 |
|
Injection, orphenadrine citrate, up to 60 mg
| short | Orphenadrine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2370 |
|
Injection, phenylephrine hcl, up to 1 ml
| short | Phenylephrine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2400 |
|
Injection, chloroprocaine hydrochloride, per 30 ml
| short | Chloroprocaine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2405 |
|
Injection, ondansetron hydrochloride, per 1 mg
| short | Ondansetron hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 64.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 64.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2407 |
|
Injection, oritavancin, 10 mg
| short | Injection, oritavancin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2410 |
|
Injection, oxymorphone hcl, up to 1 mg
| short | Oxymorphone hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2425 |
|
Injection, palifermin, 50 micrograms
| short | Palifermin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 125.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 125.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2426 |
|
Injection, paliperidone palmitate extended release, 1 mg
| short | Paliperidone palmitate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 819.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 819.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2430 |
|
Injection, pamidronate disodium, per 30 mg
| short | Pamidronate disodium /30 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2440 |
|
Injection, papaverine hcl, up to 60 mg
| short | Papaverin hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2460 |
|
Injection, oxytetracycline hcl, up to 50 mg
| short | Oxytetracycline injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2469 |
|
Injection, palonosetron hcl, 25 mcg
| short | Palonosetron hcl |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2501 |
|
Injection, paricalcitol, 1 mcg
| short | Paricalcitol |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2502 |
|
Injection, pasireotide long acting, 1 mg
| short | Inj, pasireotide long acting |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2503 |
|
Injection, pegaptanib sodium, 0.3 mg
| short | Pegaptanib sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2504 |
|
Injection, pegademase bovine, 25 iu
| short | Pegademase bovine, 25 iu |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2505 |
|
Injection, pegfilgrastim, 6 mg
| short | Injection, pegfilgrastim 6mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2507 |
|
Injection, pegloticase, 1 mg
| short | Pegloticase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2510 |
|
Injection, penicillin g procaine, aqueous, up to 600,000 units
| short | Penicillin g procaine inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2513 |
|
Injection, pentastarch, 10% solution, 100 ml
| short | Pentastarch 10% solution |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2515 |
|
Injection, pentobarbital sodium, per 50 mg
| short | Pentobarbital sodium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2540 |
|
Injection, penicillin g potassium, up to 600,000 units
| short | Penicillin g potassium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 75.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 75.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2543 |
|
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)
| short | Piperacillin/tazobactam |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2545 |
|
Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg
| short | Pentamidine non-comp unit |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J2547 |
|
Injection, peramivir, 1 mg
| short | Injection, peramivir |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2550 |
|
Injection, promethazine hcl, up to 50 mg
| short | Promethazine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2560 |
|
Injection, phenobarbital sodium, up to 120 mg
| short | Phenobarbital sodium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2562 |
|
Injection, plerixafor, 1 mg
| short | Plerixafor injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 48.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 48.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2590 |
|
Injection, oxytocin, up to 10 units
| short | Oxytocin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2597 |
|
Injection, desmopressin acetate, per 1 mcg
| short | Inj desmopressin acetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 45.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 45.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2650 |
|
Injection, prednisolone acetate, up to 1 ml
| short | Prednisolone acetate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2670 |
|
Injection, tolazoline hcl, up to 25 mg
| short | Totazoline hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2675 |
|
Injection, progesterone, per 50 mg
| short | Inj progesterone per 50 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2680 |
|
Injection, fluphenazine decanoate, up to 25 mg
| short | Fluphenazine decanoate 25 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2690 |
|
Injection, procainamide hcl, up to 1 gm
| short | Procainamide hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2700 |
|
Injection, oxacillin sodium, up to 250 mg
| short | Oxacillin sodium injeciton |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 48.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 48.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2704 |
|
Injection, propofol, 10 mg
| short | Inj, propofol, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 80.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2710 |
|
Injection, neostigmine methylsulfate, up to 0.5 mg
| short | Neostigmine methylslfte inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2720 |
|
Injection, protamine sulfate, per 10 mg
| short | Inj protamine sulfate/10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2724 |
|
Injection, protein c concentrate, intravenous, human, 10 iu
| short | Protein c concentrate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3500.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 3500.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2725 |
|
Injection, protirelin, per 250 mcg
| short | Inj protirelin per 250 mcg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2730 |
|
Injection, pralidoxime chloride, up to 1 gm
| short | Pralidoxime chloride inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2760 |
|
Injection, phentolamine mesylate, up to 5 mg
| short | Phentolaine mesylate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2765 |
|
Injection, metoclopramide hcl, up to 10 mg
| short | Metoclopramide hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 18.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2770 |
|
Injection, quinupristin/dalfopristin, 500 mg (150/350)
| short | Quinupristin/dalfopristin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 7.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2778 |
|
Injection, ranibizumab, 0.1 mg
| short | Ranibizumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2780 |
|
Injection, ranitidine hydrochloride, 25 mg
| short | Ranitidine hydrochloride inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2783 |
|
Injection, rasburicase, 0.5 mg
| short | Rasburicase |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2785 |
|
Injection, regadenoson, 0.1 mg
| short | Regadenoson injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2786 |
|
Injection, reslizumab, 1 mg
| short | Injection, reslizumab, 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 500.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 500.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2787 |
|
Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml
| short | Riboflavin 5'phos opth<=3ml |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J2788 |
|
Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.)
| short | Rho d immune globulin 50 mcg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2790 |
|
Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)
| short | Rho d immune globulin inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2791 |
|
Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu
| short | Rhophylac injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 15.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2792 |
|
Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu
| short | Rho(d) immune globulin h, sd |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 450.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 450.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2793 |
|
Injection, rilonacept, 1 mg
| short | Rilonacept injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 320.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 320.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2794 |
|
Injection, risperidone (risperdal consta), 0.5 mg
| short | Inj risperdal consta, 0.5 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2795 |
|
Injection, ropivacaine hydrochloride, 1 mg
| short | Ropivacaine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2400.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2796 |
|
Injection, romiplostim, 10 micrograms
| short | Romiplostim injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2797 |
|
Injection, rolapitant, 0.5 mg
| short | Inj., rolapitant, 0.5 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 333.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 333.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J2798 |
|
Injection, risperidone, (perseris), 0.5 mg
| short | Inj., perseris, 0.5 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J2800 |
|
Injection, methocarbamol, up to 10 ml
| short | Methocarbamol injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2805 |
|
Injection, sincalide, 5 micrograms
| short | Sincalide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2810 |
|
Injection, theophylline, per 40 mg
| short | Inj theophylline per 40 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2820 |
|
Injection, sargramostim (gm-csf), 50 mcg
| short | Sargramostim injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 15.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2840 |
|
Injection, sebelipase alfa, 1 mg
| short | Inj sebelipase alfa 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2850 |
|
Injection, secretin, synthetic, human, 1 microgram
| short | Inj secretin synthetic human |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 16.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 48.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2860 |
|
Injection, siltuximab, 10 mg
| short | Injection, siltuximab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 170.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 170.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2910 |
|
Injection, aurothioglucose, up to 50 mg
| short | Aurothioglucose injeciton |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2916 |
|
Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg
| short | Na ferric gluconate complex |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2920 |
|
Injection, methylprednisolone sodium succinate, up to 40 mg
| short | Methylprednisolone injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J2930 |
|
Injection, methylprednisolone sodium succinate, up to 125 mg
| short | Methylprednisolone injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J2940 |
|
Injection, somatrem, 1 mg
| short | Somatrem injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2941 |
|
Injection, somatropin, 1 mg
| short | Somatropin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2950 |
|
Injection, promazine hcl, up to 25 mg
| short | Promazine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2993 |
|
Injection, reteplase, 18.1 mg
| short | Reteplase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J2995 |
|
Injection, streptokinase, per 250,000 iu
| short | Inj streptokinase /250000 iu |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J2997 |
|
Injection, alteplase recombinant, 1 mg
| short | Alteplase recombinant |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3000 |
|
Injection, streptomycin, up to 1 gm
| short | Streptomycin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3010 |
|
Injection, fentanyl citrate, 0.1 mg
| short | Fentanyl citrate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 700.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J3030 |
|
Injection, sumatriptan succinate, 6 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)
| short | Sumatriptan succinate / 6 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3031 |
|
Injection, fremanezumab-vfrm, 1 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)
| short | Inj., fremanezumab-vfrm 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 675.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 675.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J3060 |
|
Injection, taliglucerase alfa, 10 units
| short | Inj, taliglucerase alfa 10 u |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 760.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 760.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3070 |
|
Injection, pentazocine, 30 mg
| short | Pentazocine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3090 |
|
Injection, tedizolid phosphate, 1 mg
| short | Inj tedizolid phosphate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3095 |
|
Injection, telavancin, 10 mg
| short | Telavancin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3101 |
|
Injection, tenecteplase, 1 mg
| short | Tenecteplase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3105 |
|
Injection, terbutaline sulfate, up to 1 mg
| short | Terbutaline sulfate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3110 |
|
Injection, teriparatide, 10 mcg
| short | Teriparatide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3111 |
|
Injection, romosozumab-aqqg, 1 mg
| short | Inj. romosozumab-aqqg 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J3120 |
|
Injection, testosterone enanthate, up to 100 mg
| short | Testosterone enanthate inj |
|
|
|
J3121 |
|
Injection, testosterone enanthate, 1 mg
| short | Inj testostero enanthate 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3130 |
|
Injection, testosterone enanthate, up to 200 mg
| short | Testosterone enanthate inj |
|
|
|
J3140 |
|
Injection, testosterone suspension, up to 50 mg
| short | Testosterone suspension inj |
|
|
|
J3145 |
|
Injection, testosterone undecanoate, 1 mg
| short | Testosterone undecanoate 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 750.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 750.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3150 |
|
Injection, testosterone propionate, up to 100 mg
| short | Testosteron propionate inj |
|
|
|
J3230 |
|
Injection, chlorpromazine hcl, up to 50 mg
| short | Chlorpromazine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3240 |
|
Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial
| short | Thyrotropin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3243 |
|
Injection, tigecycline, 1 mg
| short | Tigecycline injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3245 |
|
Injection, tildrakizumab, 1 mg
| short | Inj., tildrakizumab, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J3246 |
|
Injection, tirofiban hcl, 0.25 mg
| short | Tirofiban hcl |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3250 |
|
Injection, trimethobenzamide hcl, up to 200 mg
| short | Trimethobenzamide hcl inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3260 |
|
Injection, tobramycin sulfate, up to 80 mg
| short | Tobramycin sulfate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3262 |
|
Injection, tocilizumab, 1 mg
| short | Tocilizumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 800.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 800.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3265 |
|
Injection, torsemide, 10 mg/ml
| short | Injection torsemide 10 mg/ml |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3280 |
|
Injection, thiethylperazine maleate, up to 10 mg
| short | Thiethylperazine maleate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3285 |
|
Injection, treprostinil, 1 mg
| short | Treprostinil injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 9.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J3300 |
|
Injection, triamcinolone acetonide, preservative free, 1 mg
| short | Triamcinolone a inj prs-free |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3301 |
|
Injection, triamcinolone acetonide, not otherwise specified, 10 mg
| short | Triamcinolone acet inj nos |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3302 |
|
Injection, triamcinolone diacetate, per 5 mg
| short | Triamcinolone diacetate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3303 |
|
Injection, triamcinolone hexacetonide, per 5 mg
| short | Triamcinolone hexacetonl inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 24.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 24.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3304 |
|
Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
| short | Inj triamcinolone ace xr 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 64.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | OPH | 64.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
J3305 |
|
Injection, trimetrexate glucuronate, per 25 mg
| short | Inj trimetrexate glucoronate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3310 |
|
Injection, perphenazine, up to 5 mg
| short | Perphenazine injeciton |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3315 |
|
Injection, triptorelin pamoate, 3.75 mg
| short | Triptorelin pamoate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3316 |
|
Injection, triptorelin, extended-release, 3.75 mg
| short | Inj., triptorelin xr 3.75 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J3320 |
|
Injection, spectinomycin dihydrochloride, up to 2 gm
| short | Spectinomycn di-hcl inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3350 |
|
Injection, urea, up to 40 gm
| short | Urea injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3355 |
|
Injection, urofollitropin, 75 iu
| short | Urofollitropin, 75 iu |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3357 |
|
Ustekinumab, for subcutaneous injection, 1 mg
| short | Ustekinumab sub cu inj, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 90.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 90.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3358 |
|
Ustekinumab, for intravenous injection, 1 mg
| short | Ustekinumab, iv inject, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 520.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 520.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3360 |
|
Injection, diazepam, up to 5 mg
| short | Diazepam injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3364 |
|
Injection, urokinase, 5000 iu vial
| short | Urokinase 5000 iu injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3365 |
|
Injection, iv, urokinase, 250,000 i.u. vial
| short | Urokinase 250,000 iu inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3370 |
|
Injection, vancomycin hcl, 500 mg
| short | Vancomycin hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3380 |
|
Injection, vedolizumab, 1 mg
| short | Injection, vedolizumab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3385 |
|
Injection, velaglucerase alfa, 100 units
| short | Velaglucerase alfa |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 80.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 80.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3396 |
|
Injection, verteporfin, 0.1 mg
| short | Verteporfin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3397 |
|
Injection, vestronidase alfa-vjbk, 1 mg
| short | Inj., vestronidase alfa-vjbk |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J3398 |
|
Injection, voretigene neparvovec-rzyl, 1 billion vector genomes
| short | Inj luxturna 1 billion vec g |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 2 Date of Service Edit: Policy | CMS Policy | | OPH | 150.0 | 2 Date of Service Edit: Policy | CMS Policy |
|
|
|
|
J3400 |
|
Injection, triflupromazine hcl, up to 20 mg
| short | Triflupromazine hcl inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3410 |
|
Injection, hydroxyzine hcl, up to 25 mg
| short | Hydroxyzine hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 16.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3411 |
|
Injection, thiamine hcl, 100 mg
| short | Thiamine hcl 100 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3415 |
|
Injection, pyridoxine hcl, 100 mg
| short | Pyridoxine hcl 100 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3420 |
|
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg
| short | Vitamin b12 injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3430 |
|
Injection, phytonadione (vitamin k), per 1 mg
| short | Vitamin k phytonadione inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 25.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3465 |
|
Injection, voriconazole, 10 mg
| short | Injection, voriconazole |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 40.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3470 |
|
Injection, hyaluronidase, up to 150 units
| short | Hyaluronidase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3471 |
|
Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)
| short | Ovine, up to 999 usp units |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 999.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | OPH | 999.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3472 |
|
Injection, hyaluronidase, ovine, preservative free, per 1000 usp units
| short | Ovine, 1000 usp units |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3473 |
|
Injection, hyaluronidase, recombinant, 1 usp unit
| short | Hyaluronidase recombinant |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 450.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 450.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3475 |
|
Injection, magnesium sulfate, per 500 mg
| short | Inj magnesium sulfate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 80.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3480 |
|
Injection, potassium chloride, per 2 meq
| short | Inj potassium chloride |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 40.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3485 |
|
Injection, zidovudine, 10 mg
| short | Zidovudine |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 160.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 160.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3486 |
|
Injection, ziprasidone mesylate, 10 mg
| short | Ziprasidone mesylate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3489 |
|
Injection, zoledronic acid, 1 mg
| short | Zoledronic acid 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3490 |
|
Unclassified drugs
| short | Drugs unclassified injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J3520 |
|
Edetate disodium, per 150 mg
| short | Edetate disodium per 150 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J3530 |
|
Nasal vaccine inhalation
| short | Nasal vaccine inhalation |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3535 |
|
Drug administered through a metered dose inhaler
| short | Metered dose inhaler drug |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3570 |
|
Laetrile, amygdalin, vitamin b17
| short | Laetrile amygdalin vit b17 |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J3590 |
|
Unclassified biologics
| short | Unclassified biologics |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J3591 |
|
Unclassified drug or biological used for esrd on dialysis
| short | Esrd on dialysi drug/bio noc |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J7030 |
|
Infusion, normal saline solution , 1000 cc
| short | Normal saline solution infus |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7040 |
|
Infusion, normal saline solution, sterile (500 ml = 1 unit)
| short | Normal saline solution infus |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7042 |
|
5% dextrose/normal saline (500 ml = 1 unit)
| short | 5% dextrose/normal saline |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7050 |
|
Infusion, normal saline solution, 250 cc
| short | Normal saline solution infus |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7060 |
|
5% dextrose/water (500 ml = 1 unit)
| short | 5% dextrose/water |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7070 |
|
Infusion, d5w, 1000 cc
| short | D5w infusion |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 7.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7100 |
|
Infusion, dextran 40, 500 ml
| short | Dextran 40 infusion |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7110 |
|
Infusion, dextran 75, 500 ml
| short | Dextran 75 infusion |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7120 |
|
Ringers lactate infusion, up to 1000 cc
| short | Ringers lactate infusion |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7121 |
|
5% dextrose in lactated ringers infusion, up to 1000 cc
| short | 5% dextrose in lac ringers |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J7131 |
|
Hypertonic saline solution, 1 ml
| short | Hypertonic saline sol |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 500.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 500.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|