Q4081 HCPCS - INJECTION, EPOETIN ALFA, 100 UNITS (FOR ESRD ON DIALYSIS)

Code Information

Berenson-Eggers Type Of Service Code: O1E - Other drugs
Type Of Service Code:
- 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96
- L - ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)

Pricing Indicator Code:
- 57 - Other carrier priced
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:
- 4273.1
Coverage Code: D - Special coverage instructions apply

Field Name	Field Value
Healthcare Common Procedure Coding System Code	Q4081
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, epoetin alfa, 100 units (for esrd on dialysis)
HCPCS Short Description	Epoetin alfa, 100 units esrd
HCPCS Pricing Indicator Code 1	57 - Other carrier priced
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Medicare Carriers Manual Reference Section Number 1	4273.1
HCPCS Coverage Code	D - Special coverage instructions apply
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	L - ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	1/1/2007
HCPCS Action Effective Date	1/1/2007
HCPCS Action Code	N - No maintenance for this code