Field Name |
Field Value |
Healthcare Common Procedure Coding System Code |
C9139 |
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 |
Injection, factor ix, albumin fusion protein (recombinant), idelvion, 1 i.u. |
HCPCS Short Description |
Idelvion, 1 i.u. |
HCPCS Pricing Indicator Code 1 |
53 - Statute |
HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
HCPCS Statute Number |
1833(t) |
HCPCS Cross Reference Code 1 |
J7202 |
HCPCS Coverage Code |
D - Special coverage instructions apply |
HCPCS Berenson-Eggers Type Of Service Code |
O1E - Other drugs |
HCPCS Type Of Service Code 1 |
9 - Other medical items or services |
HCPCS Type Of Service Code 2 |
F - Ambulatory surgical center (facility usage for surgical services) |
HCPCS Anesthesia Base Unit Quantity |
0 |
HCPCS Code Added Date |
10/1/2016 |
HCPCS Action Effective Date |
1/1/2017 |
HCPCS Termination Date |
12/31/2016 |
HCPCS Action Code |
N - No maintenance for this code |