|
J7604 |
 |
Acetylcysteine, inhalation solution, compounded product, administered through dme, unit dose form, per gram
| short | Acetylcysteine 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7605 |
|
Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms
| short | Arformoterol 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 | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 186.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J7606 |
|
Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms
| short | Formoterol fumarate, inh |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 186.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J7607 |
|
Levalbuterol, inhalation solution, compounded product, administered through dme, concentrated form, 0.5 mg
| short | Levalbuterol comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7608 |
|
Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram
| short | Acetylcysteine 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 | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 222.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J7609 |
|
Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg
| short | Albuterol 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7610 |
|
Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg
| short | Albuterol comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7611 |
|
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg
| short | Albuterol non-comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1395.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J7612 |
|
Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg
| short | Levalbuterol non-comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 900.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J7613 |
|
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg
| short | Albuterol 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 | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1395.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J7614 |
|
Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg
| short | Levalbuterol 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 | 10.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 900.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J7615 |
|
Levalbuterol, inhalation solution, compounded product, administered through dme, unit dose, 0.5 mg
| short | Levalbuterol 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7620 |
|
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme
| short | Albuterol ipratrop non-comp |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 558.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J7622 |
|
Beclomethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Beclomethasone 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7624 |
|
Betamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Betamethasone 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7626 |
|
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg
| short | Budesonide 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 | 2.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 186.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J7627 |
|
Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg
| short | Budesonide 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7628 |
|
Bitolterol mesylate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
| short | Bitolterol mesylate comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7629 |
|
Bitolterol mesylate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Bitolterol mesylate comp unt |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7631 |
|
Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams
| short | Cromolyn sodium noncomp 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 | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 744.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J7632 |
|
Cromolyn sodium, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams
| short | Cromolyn sodium 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7633 |
|
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 0.25 milligram
| short | Budesonide non-comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
J7634 |
|
Budesonide, inhalation solution, compounded product, administered through dme, concentrated form, per 0.25 milligram
| short | Budesonide comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7635 |
|
Atropine, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
| short | Atropine comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7636 |
|
Atropine, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Atropine 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7637 |
|
Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
| short | Dexamethasone comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7638 |
|
Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Dexamethasone 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7639 |
|
Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram
| short | Dornase alfa 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 | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 234.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J7640 |
|
Formoterol, inhalation solution, compounded product, administered through dme, unit dose form, 12 micrograms
| short | Formoterol 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7641 |
|
Flunisolide, inhalation solution, compounded product, administered through dme, unit dose, per milligram
| short | Flunisolide 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7642 |
|
Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
| short | Glycopyrrolate comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7643 |
|
Glycopyrrolate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Glycopyrrolate 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7644 |
|
Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram
| short | Ipratropium bromide non-comp |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 279.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
J7645 |
|
Ipratropium bromide, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Ipratropium bromide comp |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7647 |
|
Isoetharine hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
| short | Isoetharine comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7648 |
|
Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram
| short | Isoetharine non-comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
J7649 |
|
Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram
| short | Isoetharine 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 | 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 |
|
|
|
|
J7650 |
|
Isoetharine hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Isoetharine 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7657 |
|
Isoproterenol hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
| short | Isoproterenol comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7658 |
|
Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram
| short | Isoproterenol non-comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
J7659 |
|
Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram
| short | Isoproterenol 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 | 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 |
|
|
|
|
J7660 |
|
Isoproterenol hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Isoproterenol 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7665 |
|
Mannitol, administered through an inhaler, 5 mg
| short | Mannitol for inhaler |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
J7667 |
|
Metaproterenol sulfate, inhalation solution, compounded product, concentrated form, per 10 milligrams
| short | Metaproterenol comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7668 |
|
Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 10 milligrams
| short | Metaproterenol non-comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
J7669 |
|
Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams
| short | Metaproterenol 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 | 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 |
|
|
|
|
J7670 |
|
Metaproterenol sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams
| short | Metaproterenol 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7674 |
|
Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg
| short | Methacholine chloride, neb |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
J7676 |
|
Pentamidine isethionate, inhalation solution, compounded product, administered through dme, unit dose form, per 300 mg
| short | Pentamidine comp unit dose |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7677 |
|
Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram
| short | Revefenacin inh non-com 1mcg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 175.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 175.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J7680 |
|
Terbutaline sulfate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
| short | Terbutaline sulf comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7681 |
|
Terbutaline sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Terbutaline sulf 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7682 |
|
Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams
| short | Tobramycin 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 | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 112.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J7683 |
|
Triamcinolone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
| short | Triamcinolone comp con |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7684 |
|
Triamcinolone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
| short | Triamcinolone 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7685 |
|
Tobramycin, inhalation solution, compounded product, administered through dme, unit dose form, per 300 milligrams
| short | Tobramycin 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 | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Compounded Drug Policy |
|
|
|
|
J7686 |
|
Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg
| short | Treprostinil, 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 | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 28.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|