C9058 HCPCS - INJECTION, PEGFILGRASTIM-BMEZ, BIOSIMILAR, (ZIEXTENZO) 0.5 MG

Code Information

Berenson-Eggers Type Of Service Code: O1E - Other drugs
Type Of Service Code:
- 9 - Other medical items or services
- F - Ambulatory surgical center (facility usage for surgical services)

Pricing Indicator Code:
- 53 - Statute
Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
Coverage Issues Manual Reference Section Number:
N/A
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: D - Special coverage instructions apply

Field Name	Field Value
Healthcare Common Procedure Coding System Code	C9058
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, pegfilgrastim-bmez, biosimilar, (ziextenzo) 0.5 mg
HCPCS Short Description	Injection,pegfilgrastim-bmez
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	Q5120
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	11/15/2019
HCPCS Action Effective Date	7/1/2020
HCPCS Termination Date	6/30/2020
HCPCS Action Code	N - No maintenance for this code