| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
G9765 |
| 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 that the patient declined therapy change or alternative therapies were unavailable, has documented contraindications, or has not been treated with an oral systemic or biologic for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi |
| HCPCS Short Description |
Doc pat declined therapy |
| 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 |
Z2 - Undefined codes |
| 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 |
1/1/2017 |
| HCPCS Action Effective Date |
1/1/2018 |
| HCPCS Action Code |
C - Change in long description of procedure or modifier code |