C9407 HCPCS - IODINE I-131 IOBENGUANE, DIAGNOSTIC, 1 MILLICURIE

Code Information

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	C9407
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	Iodine i-131 iobenguane, diagnostic, 1 millicurie
HCPCS Short Description	Iodine i-131 iobenguane, dx
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 Coverage Code	D - Special coverage instructions apply
HCPCS Berenson-Eggers Type Of Service Code	I1E - Standard imaging - nuclear medicine
HCPCS Type Of Service Code 1	4 - Diagnostic radiology
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	1/1/2019
HCPCS Action Effective Date	1/1/2020
HCPCS Termination Date	12/31/2019
HCPCS Action Code	N - No maintenance for this code