|
A9500 |
 |
Technetium tc-99m sestamibi, diagnostic, per study dose
| short | Tc99m sestamibi |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: Society Comment | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment |
|
|
|
|
A9501 |
|
Technetium tc-99m teboroxime, diagnostic, per study dose
| short | Technetium tc-99m teboroxime |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9502 |
|
Technetium tc-99m tetrofosmin, diagnostic, per study dose
| short | Tc99m tetrofosmin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: Society Comment | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment |
|
|
|
|
A9503 |
|
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
| short | Tc99m medronate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9504 |
|
Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries
| short | Tc99m apcitide |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9505 |
|
Thallium tl-201 thallous chloride, diagnostic, per millicurie
| short | Tl201 thallium |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9507 |
|
Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries
| short | In111 capromab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9508 |
|
Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie
| short | I131 iodobenguate, dx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9509 |
|
Iodine i-123 sodium iodide, diagnostic, per millicurie
| short | Iodine i-123 sod iodide mil |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: Society Comment | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment |
|
|
|
|
A9510 |
|
Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries
| short | Tc99m disofenin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9512 |
|
Technetium tc-99m pertechnetate, diagnostic, per millicurie
| short | Tc99m pertechnetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9513 |
|
Lutetium lu 177, dotatate, therapeutic, 1 millicurie
| short | Lutetium lu 177 dotatat ther |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9515 |
|
Choline c-11, diagnostic, per study dose up to 20 millicuries
| short | Choline c-11 |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9516 |
|
Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
| short | Iodine i-123 sod iodide mic |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9517 |
|
Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie
| short | I131 iodide cap, rx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: Society Comment | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment |
|
|
|
|
A9520 |
|
Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries
| short | Tc99 tilmanocept diag 0.5mci |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: Society Comment | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment |
|
|
|
|
A9521 |
|
Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries
| short | Tc99m exametazime |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9524 |
|
Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries
| short | I131 serum albumin, dx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9526 |
|
Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries
| short | Nitrogen n-13 ammonia |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9527 |
|
Iodine i-125, sodium iodide solution, therapeutic, per millicurie
| short | Iodine i-125 sodium iodide |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 195.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 195.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
A9528 |
|
Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie
| short | Iodine i-131 iodide cap, dx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9529 |
|
Iodine i-131 sodium iodide solution, diagnostic, per millicurie
| short | I131 iodide sol, dx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9530 |
|
Iodine i-131 sodium iodide solution, therapeutic, per millicurie
| short | I131 iodide sol, rx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: Society Comment | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment |
|
|
|
|
A9531 |
|
Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)
| short | I131 max 100uci |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9532 |
|
Iodine i-125 serum albumin, diagnostic, per 5 microcuries
| short | I125 serum albumin, dx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9536 |
|
Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries
| short | Tc99m depreotide |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9537 |
|
Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries
| short | Tc99m mebrofenin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9538 |
|
Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries
| short | Tc99m pyrophosphate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9539 |
|
Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries
| short | Tc99m pentetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9540 |
|
Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries
| short | Tc99m maa |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9541 |
|
Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries
| short | Tc99m sulfur colloid |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9542 |
|
Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries
| short | In111 ibritumomab, dx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9543 |
|
Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries
| short | Y90 ibritumomab, rx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9544 |
|
Iodine i-131 tositumomab, diagnostic, per study dose
| short | I131 tositumomab, dx |
|
|
|
A9545 |
|
Iodine i-131 tositumomab, therapeutic, per treatment dose
| short | I131 tositumomab, rx |
|
|
|
A9546 |
|
Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie
| short | Co57/58 |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9547 |
|
Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie
| short | In111 oxyquinoline |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9548 |
|
Indium in-111 pentetate, diagnostic, per 0.5 millicurie
| short | In111 pentetate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9550 |
|
Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie
| short | Tc99m gluceptate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9551 |
|
Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries
| short | Tc99m succimer |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9552 |
|
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
| short | F18 fdg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9553 |
|
Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries
| short | Cr51 chromate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9554 |
|
Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries
| short | I125 iothalamate, dx |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9555 |
|
Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries
| short | Rb82 rubidium |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9556 |
|
Gallium ga-67 citrate, diagnostic, per millicurie
| short | Ga67 gallium |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9557 |
|
Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries
| short | Tc99m bicisate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9558 |
|
Xenon xe-133 gas, diagnostic, per 10 millicuries
| short | Xe133 xenon 10mci |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 7.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
A9559 |
|
Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie
| short | Co57 cyano |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
A9560 |
|
Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries
| short | Tc99m labeled rbc |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9561 |
|
Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries
| short | Tc99m oxidronate |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9562 |
|
Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries
| short | Tc99m mertiatide |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9563 |
|
Sodium phosphate p-32, therapeutic, per millicurie
| short | P32 na 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 | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment |
|
|
|
|
A9564 |
|
Chromic phosphate p-32 suspension, therapeutic, per millicurie
| short | P32 chromic 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 | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
A9566 |
|
Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries
| short | Tc99m fanolesomab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9567 |
|
Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries
| short | Technetium tc-99m aerosol |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Code Descriptor / CPT Instruction | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9568 |
|
Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries
| short | Technetium tc99m arcitumomab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9569 |
|
Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
| short | Technetium tc-99m auto wbc |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9570 |
|
Indium in-111 labeled autologous white blood cells, diagnostic, per study dose
| short | Indium in-111 auto wbc |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9571 |
|
Indium in-111 labeled autologous platelets, diagnostic, per study dose
| short | Indium in-111 auto platelet |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9572 |
|
Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries
| short | Indium in-111 pentetreotide |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9575 |
|
Injection, gadoterate meglumine, 0.1 ml
| short | Inj gadoterate meglumi 0.1ml |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9576 |
|
Injection, gadoteridol, (prohance multipack), per ml
| short | Inj prohance multipack |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
A9577 |
|
Injection, gadobenate dimeglumine (multihance), per ml
| short | Inj multihance |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: CMS Workgroup | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
A9578 |
|
Injection, gadobenate dimeglumine (multihance multipack), per ml
| short | Inj multihance multipack |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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: CMS Workgroup | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
A9579 |
|
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml
| short | Gad-base mr contrast nos,1ml |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9580 |
|
Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries
| short | Sodium fluoride f-18 |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Nature of Service/Procedure | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Nature of Service/Procedure |
|
|
|
|
A9581 |
|
Injection, gadoxetate disodium, 1 ml
| short | Gadoxetate 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 | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
A9582 |
|
Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries
| short | Iodine i-123 iobenguane |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9583 |
|
Injection, gadofosveset trisodium, 1 ml
| short | Gadofosveset trisodium 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 | 18.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 18.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
A9584 |
|
Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
| short | Iodine i-123 ioflupane |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9585 |
|
Injection, gadobutrol, 0.1 ml
| short | Gadobutrol 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 |
|
|
|
|
A9586 |
|
Florbetapir f18, diagnostic, per study dose, up to 10 millicuries
| short | Florbetapir f18 |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | YYY |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9587 |
|
Gallium ga-68, dotatate, diagnostic, 0.1 millicurie
| short | Gallium ga-68 |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 54.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 54.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
A9588 |
|
Fluciclovine f-18, diagnostic, 1 millicurie
| short | Fluciclovine f-18 |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 |
|
|
|
|
A9589 |
|
Instillation, hexaminolevulinate hydrochloride, 100 mg
| short | Insti hexaminolevulinate 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 | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
A9590 |
|
Iodine i-131, iobenguane, 1 millicurie
| short | Iodine i-131 iobenguane 1mci |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
A9597 |
|
Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified
| short | Pet, dx, for tumor id, 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 |
|
|
|
|
A9598 |
|
Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified
| short | Pet dx for non-tumor id, 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 |
|
|
|
|
A9599 |
|
Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified
| short | Radioph dx b amyloid pet nos |
|
|
|
A9600 |
|
Strontium sr-89 chloride, therapeutic, per millicurie
| short | Sr89 strontium |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 7.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
A9604 |
|
Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
| short | Sm 153 lexidronam |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 1.0 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
|
|
|
|
A9606 |
|
Radium ra-223 dichloride, therapeutic, per microcurie
| short | Radium ra223 dichloride ther |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 224.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 224.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
A9698 |
|
Non-radioactive contrast imaging material, not otherwise classified, per study
| short | Non-rad contrast materialnoc |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | 3.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
A9699 |
|
Radiopharmaceutical, therapeutic, not otherwise classified
| short | Radiopharm rx agent 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 |
|
|
|
|
A9700 |
|
Supply of injectable contrast material for use in echocardiography, per study
| short | Echocardiography contrast |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | 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 | Nature of Service/Procedure | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Nature of Service/Procedure |
|
|
|