| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
J0641 |
| 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, levoleucovorin calcium, 0.5 mg |
| HCPCS Short Description |
Levoleucovorin injection |
| HCPCS Pricing Indicator Code 1 |
51 - Drugs |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Coverage Code |
D - Special coverage instructions apply |
| HCPCS ASC Payment Group Code |
YY |
| HCPCS ASC Payment Group Effective Date |
1/1/2009 |
| HCPCS Processing Note Number |
0127 |
| 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 |
1/1/2009 |
| HCPCS Action Effective Date |
1/1/2009 |
| HCPCS Action Code |
N - No maintenance for this code |