| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
J3520 |
| 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 |
Edetate disodium, per 150 mg |
| HCPCS Short Description |
Edetate disodium per 150 mg |
| 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 Issues Manual Reference Section Number 1 |
35-64 |
| HCPCS Coverage Issues Manual Reference Section Number 2 |
45-20 |
| HCPCS Coverage Code |
M - Non-covered by Medicare |
| HCPCS Berenson-Eggers Type Of Service Code |
O1E - Other drugs |
| HCPCS Type Of Service Code 1 |
1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96 |
| HCPCS Type Of Service Code 2 |
P - Lump sum purchase of DME, prosthetics, orthotics |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/1986 |
| HCPCS Action Effective Date |
1/1/1996 |
| HCPCS Action Code |
N - No maintenance for this code |