| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
A4220 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS Long Description |
Refill kit for implantable infusion pump |
| HCPCS Short Description |
Infusion pump refill kit |
| HCPCS Pricing Indicator Code 1 |
57 - Other carrier priced |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Coverage Issues Manual Reference Section Number 1 |
60-14 |
| HCPCS Coverage Code |
D - Special coverage instructions apply |
| HCPCS Processing Note Number |
0050 |
| HCPCS Berenson-Eggers Type Of Service Code |
D1A - Medical/surgical supplies |
| HCPCS Type Of Service Code 1 |
P - Lump sum purchase of DME, prosthetics, orthotics |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/1994 |
| HCPCS Action Effective Date |
3/3/1998 |
| HCPCS Action Code |
N - No maintenance for this code |