| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
G0921 |
| 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 |
Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment) |
| HCPCS Short Description |
Doc pt reas no assess |
| HCPCS Pricing Indicator Code 1 |
00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.) |
| HCPCS Multiple Pricing Indicator Code |
9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99') |
| HCPCS Coverage Code |
C - Carrier judgment |
| HCPCS Berenson-Eggers Type Of Service Code |
M5D - Specialist - other |
| HCPCS Type Of Service Code 1 |
1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96 |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/2012 |
| HCPCS Action Effective Date |
1/1/2015 |
| HCPCS Termination Date |
12/31/2014 |
| HCPCS Action Code |
N - No maintenance for this code |