|
Q2004 |
 |
Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml
| short | Bladder calculi irrig 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 | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
Q2009 |
|
Injection, fosphenytoin, 50 mg phenytoin equivalent
| short | Fosphenytoin inj pe |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: Data |
|
|
|
|
Q2017 |
|
Injection, teniposide, 50 mg
| short | Teniposide, 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 | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
Q2026 |
|
Injection, radiesse, 0.1 ml
| short | Radiesse 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 |
|
|
|
|
Q2028 |
|
Injection, sculptra, 0.5 mg
| short | Inj, sculptra, 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 | 1470.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 1470.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
Q2034 |
|
Influenza virus vaccine, split virus, for intramuscular use (agriflu)
| short | Agriflu vaccine |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Nature of Service/Procedure | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Service/Procedure |
|
|
|
|
Q2035 |
|
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
| short | Afluria vacc, 3 yrs & >, im |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Nature of Service/Procedure | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Service/Procedure |
|
|
|
|
Q2036 |
|
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
| short | Flulaval vacc, 3 yrs & >, im |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Nature of Service/Procedure | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Service/Procedure |
|
|
|
|
Q2037 |
|
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
| short | Fluvirin vacc, 3 yrs & >, im |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Nature of Service/Procedure | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Service/Procedure |
|
|
|
|
Q2038 |
|
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
| short | Fluzone vacc, 3 yrs & >, im |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Nature of Service/Procedure | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Service/Procedure |
|
|
|
|
Q2039 |
|
Influenza virus vaccine, not otherwise specified
| short | Influenza virus vaccine, 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 | 1.0 | 2 Date of Service Edit: Policy | Nature of Service/Procedure | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Service/Procedure |
|
|
|
|
Q2040 |
|
Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion
| short | Tisagenlecleucel car-pos t |
|
|
|
Q2041 |
|
Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
| short | Axicabtagene ciloleucel car+ |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
Q2042 |
|
Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
| short | Tisagenlecleucel car-pos t |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
Q2043 |
|
Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion
| short | Sipuleucel-t auto cd54+ |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
Q2049 |
|
Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg
| short | Imported lipodox 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 | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
Q2050 |
|
Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg
| short | Doxorubicin inj 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 | 14.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
Q2052 |
|
Services, supplies and accessories used in the home under the medicare intravenous immune globulin (ivig) demonstration
| short | Ivig demo, services/supplies |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Published Contractor Policy |
|
|
|