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2018
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2018

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CMS Transmittals



IMPORTANT NOTICE: Updated W-9 for new address 3/1/18 available here.


Q2040
Quick jump to procedure code: Printer Friendly Version
Q2049

Procedure Category: HCPC Level II Codes
Procedure Subcategory: Temporary Codes

Q2043: Sipuleucel-t auto cd54+

HCPCS
Q2043: Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion


--


2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

July 2018 ASP Payment Allowance Limits for Medicare Part B Drugs:
Sipuleucel-t auto cd54+, Per infusion (minimum 50 million cells) $41532.64
2018 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2018C Unadjusted OPPS Payment $41532.64
2018 APC Code: 9273
Sipuleucel-T auto CD54+

2018 OPPS Status Indicator: K

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
Percentage
ICD-10 Code
Description
Related DRG(s)
88.6%
C61
Malignant neoplasm of prostate
715-718
722-724
11.4%
C79.51
Secondary malignant neoplasm of bone
456-458
542-544

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

Q2043 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for Q2043
Denied Codes (1)
Effective
Modifier
Accepted (2)
0213T NJX PARAVERT W/US CER/THOR
07/01/2011 No
0216T NJX PARAVERT W/US LUMB/SAC
07/01/2011 No
0228T NJX TFRML EPRL W/US CER/THOR
07/01/2011 No
0230T NJX TFRML EPRL W/US LUMB/SAC
07/01/2011 No
36000 PLACE NEEDLE IN VEIN
07/01/2011 Yes
36400 BL DRAW < 3 YRS FEM/JUGULAR
07/01/2011 Yes
36405 BL DRAW <3 YRS SCALP VEIN
07/01/2011 Yes
36406 BL DRAW <3 YRS OTHER VEIN
07/01/2011 Yes
36410 NON-ROUTINE BL DRAW 3/> YRS
07/01/2011 Yes
36420 VEIN ACCESS CUTDOWN < 1 YR
07/01/2011 Yes
36425 VEIN ACCESS CUTDOWN > 1 YR
07/01/2011 Yes
36430 BLOOD TRANSFUSION SERVICE
07/01/2011 Yes
36440 BL PUSH TRANSFUSE 2 YR/<
07/01/2011 Yes
36512 APHERESIS RBC
07/01/2011 No
36513 APHERESIS PLATELETS
07/01/2011 No
36514 APHERESIS PLASMA
07/01/2011 No
36516 APHERESIS IMMUNOADS SLCTV
07/01/2011 No
36600 WITHDRAWAL OF ARTERIAL BLOOD
07/01/2011 Yes
36640 INSERTION CATHETER ARTERY
07/01/2011 Yes
38206 HARVEST AUTO STEM CELLS
07/01/2011 No
38210 T-CELL DEPLETION OF HARVEST
07/01/2011 No
38211 TUMOR CELL DEPLETE OF HARVST
07/01/2011 No
38212 RBC DEPLETION OF HARVEST
07/01/2011 No
38213 PLATELET DEPLETE OF HARVEST
07/01/2011 No
38214 VOLUME DEPLETE OF HARVEST
07/01/2011 No
38215 HARVEST STEM CELL CONCENTRTE
07/01/2011 No
38241 TRANSPLT AUTOL HCT/DONOR
07/01/2011 No
43752 NASAL/OROGASTRIC W/TUBE PLMT
07/01/2011 Yes
51701 INSERT BLADDER CATHETER
07/01/2011 Yes
51702 INSERT TEMP BLADDER CATH
07/01/2011 Yes
51703 INSERT BLADDER CATH COMPLEX
07/01/2011 Yes
61650 EVASC PRLNG ADMN RX AGNT 1ST
01/01/2016 Yes
62320 NJX INTERLAMINAR CRV/THRC
01/01/2017 No
62321 NJX INTERLAMINAR CRV/THRC
01/01/2017 No
62322 NJX INTERLAMINAR LMBR/SAC
01/01/2017 No
62323 NJX INTERLAMINAR LMBR/SAC
01/01/2017 No
62324 NJX INTERLAMINAR CRV/THRC
01/01/2017 No
62325 NJX INTERLAMINAR CRV/THRC
01/01/2017 No
62326 NJX INTERLAMINAR LMBR/SAC
01/01/2017 No
62327 NJX INTERLAMINAR LMBR/SAC
01/01/2017 No
64400 N BLOCK INJ TRIGEMINAL
07/01/2011 No
64402 N BLOCK INJ FACIAL
07/01/2011 No
64405 N BLOCK INJ OCCIPITAL
07/01/2011 No
64408 N BLOCK INJ VAGUS
07/01/2011 No
64410 N BLOCK INJ PHRENIC
07/01/2011 No
64413 N BLOCK INJ CERVICAL PLEXUS
07/01/2011 No
64415 N BLOCK INJ BRACHIAL PLEXUS
07/01/2011 No
64416 N BLOCK CONT INFUSE B PLEX
07/01/2011 No
64417 N BLOCK INJ AXILLARY
07/01/2011 No
64418 N BLOCK INJ SUPRASCAPULAR
07/01/2011 No
64420 N BLOCK INJ INTERCOST SNG
07/01/2011 No
64421 N BLOCK INJ INTERCOST MLT
07/01/2011 No
64425 N BLOCK INJ ILIO-ING/HYPOGI
07/01/2011 No
64430 N BLOCK INJ PUDENDAL
07/01/2011 No
64435 N BLOCK INJ PARACERVICAL
07/01/2011 No
64445 N BLOCK INJ SCIATIC SNG
07/01/2011 No
64446 N BLK INJ SCIATIC CONT INF
07/01/2011 No
64447 N BLOCK INJ FEM SINGLE
07/01/2011 No
64448 N BLOCK INJ FEM CONT INF
07/01/2011 No
64449 N BLOCK INJ LUMBAR PLEXUS
07/01/2011 No
64450 N BLOCK OTHER PERIPHERAL
07/01/2011 No
64461 PVB THORACIC SINGLE INJ SITE
01/01/2016 No
64463 PVB THORACIC CONT INFUSION
01/01/2016 No
64479 INJ FORAMEN EPIDURAL C/T
07/01/2011 No
64483 INJ FORAMEN EPIDURAL L/S
07/01/2011 No
64486 TAP BLOCK UNIL BY INJECTION
01/01/2015 No
64487 TAP BLOCK UNI BY INFUSION
01/01/2015 No
64488 TAP BLOCK BI INJECTION
01/01/2015 No
64489 TAP BLOCK BI BY INFUSION
01/01/2015 No
64490 INJ PARAVERT F JNT C/T 1 LEV
07/01/2011 No
64493 INJ PARAVERT F JNT L/S 1 LEV
07/01/2011 No
64505 N BLOCK SPENOPALATINE GANGL
07/01/2011 No
64508 N BLOCK CAROTID SINUS S/P
07/01/2011 No
64510 N BLOCK STELLATE GANGLION
07/01/2011 No
64517 N BLOCK INJ HYPOGAS PLXS
07/01/2011 No
64520 N BLOCK LUMBAR/THORACIC
07/01/2011 No
64530 N BLOCK INJ CELIAC PELUS
07/01/2011 No
69990 MICROSURGERY ADD-ON
07/01/2011 No
93000 ELECTROCARDIOGRAM COMPLETE
07/01/2011 Yes
93005 ELECTROCARDIOGRAM TRACING
07/01/2011 Yes
93010 ELECTROCARDIOGRAM REPORT
07/01/2011 Yes
93040 RHYTHM ECG WITH REPORT
07/01/2011 Yes
93041 RHYTHM ECG TRACING
07/01/2011 Yes
93042 RHYTHM ECG REPORT
07/01/2011 Yes
93318 ECHO TRANSESOPHAGEAL INTRAOP
07/01/2011 Yes
93355 ECHO TRANSESOPHAGEAL (TEE)
01/01/2015 Yes
94002 VENT MGMT INPAT INIT DAY
07/01/2011 Yes
94200 LUNG FUNCTION TEST (MBC/MVV)
07/01/2011 Yes
94250 EXPIRED GAS COLLECTION
07/01/2011 Yes
94680 EXHALED AIR ANALYSIS O2
07/01/2011 Yes
94681 EXHALED AIR ANALYSIS O2/CO2
07/01/2011 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
94690 EXHALED AIR ANALYSIS
07/01/2011 Yes
94770 EXHALED CARBON DIOXIDE TEST
07/01/2011 Yes
95812 EEG 41-60 MINUTES
07/01/2011 Yes
95813 EEG OVER 1 HOUR
07/01/2011 Yes
95816 EEG AWAKE AND DROWSY
07/01/2011 Yes
95819 EEG AWAKE AND ASLEEP
07/01/2011 Yes
95822 EEG COMA OR SLEEP ONLY
07/01/2011 Yes
95829 SURGERY ELECTROCORTICOGRAM
07/01/2011 Yes
95955 EEG DURING SURGERY
07/01/2011 Yes
99155 MOD SED OTH PHYS/QHP <5 YRS
01/01/2017 No
99156 MOD SED OTH PHYS/QHP 5/>YRS
01/01/2017 No
99157 MOD SED OTHER PHYS/QHP EA
01/01/2017 No
99201 OFFICE/OUTPATIENT VISIT NEW
07/01/2011 Yes
99202 OFFICE/OUTPATIENT VISIT NEW
07/01/2011 Yes
99203 OFFICE/OUTPATIENT VISIT NEW
07/01/2011 Yes
99204 OFFICE/OUTPATIENT VISIT NEW
07/01/2011 Yes
99205 OFFICE/OUTPATIENT VISIT NEW
07/01/2011 Yes
99211 OFFICE/OUTPATIENT VISIT EST
07/01/2011 Yes
99212 OFFICE/OUTPATIENT VISIT EST
07/01/2011 Yes
99213 OFFICE/OUTPATIENT VISIT EST
07/01/2011 Yes
99214 OFFICE/OUTPATIENT VISIT EST
07/01/2011 Yes
99215 OFFICE/OUTPATIENT VISIT EST
07/01/2011 Yes
99217 OBSERVATION CARE DISCHARGE
07/01/2011 Yes
99218 INITIAL OBSERVATION CARE
07/01/2011 Yes
99219 INITIAL OBSERVATION CARE
07/01/2011 Yes
99220 INITIAL OBSERVATION CARE
07/01/2011 Yes
99224 SUBSEQUENT OBSERVATION CARE
07/01/2011 Yes
99225 SUBSEQUENT OBSERVATION CARE
07/01/2011 Yes
99226 SUBSEQUENT OBSERVATION CARE
07/01/2011 Yes
99231 SUBSEQUENT HOSPITAL CARE
07/01/2011 Yes
99232 SUBSEQUENT HOSPITAL CARE
07/01/2011 Yes
99233 SUBSEQUENT HOSPITAL CARE
07/01/2011 Yes
99234 OBSERV/HOSP SAME DATE
07/01/2011 Yes
99235 OBSERV/HOSP SAME DATE
07/01/2011 Yes
99236 OBSERV/HOSP SAME DATE
07/01/2011 Yes
99281 EMERGENCY DEPT VISIT
07/01/2011 Yes
99282 EMERGENCY DEPT VISIT
07/01/2011 Yes
99283 EMERGENCY DEPT VISIT
07/01/2011 Yes
99284 EMERGENCY DEPT VISIT
07/01/2011 Yes
99285 EMERGENCY DEPT VISIT
07/01/2011 Yes
99291 CRITICAL CARE FIRST HOUR
07/01/2011 Yes
99292 CRITICAL CARE ADDL 30 MIN
07/01/2011 Yes
99304 NURSING FACILITY CARE INIT
07/01/2011 Yes
99305 NURSING FACILITY CARE INIT
07/01/2011 Yes
99306 NURSING FACILITY CARE INIT
07/01/2011 Yes
99307 NURSING FAC CARE SUBSEQ
07/01/2011 Yes
99308 NURSING FAC CARE SUBSEQ
07/01/2011 Yes
99309 NURSING FAC CARE SUBSEQ
07/01/2011 Yes
99310 NURSING FAC CARE SUBSEQ
07/01/2011 Yes
99315 NURSING FAC DISCHARGE DAY
07/01/2011 Yes
99316 NURSING FAC DISCHARGE DAY
07/01/2011 Yes
99318 ANNUAL NURSING FAC ASSESSMNT
07/01/2011 Yes
99324 DOMICIL/R-HOME VISIT NEW PAT
07/01/2011 Yes
99325 DOMICIL/R-HOME VISIT NEW PAT
07/01/2011 Yes
99326 DOMICIL/R-HOME VISIT NEW PAT
07/01/2011 Yes
99327 DOMICIL/R-HOME VISIT NEW PAT
07/01/2011 Yes
99328 DOMICIL/R-HOME VISIT NEW PAT
07/01/2011 Yes
99334 DOMICIL/R-HOME VISIT EST PAT
07/01/2011 Yes
99335 DOMICIL/R-HOME VISIT EST PAT
07/01/2011 Yes
99336 DOMICIL/R-HOME VISIT EST PAT
07/01/2011 Yes
99337 DOMICIL/R-HOME VISIT EST PAT
07/01/2011 Yes
99341 HOME VISIT NEW PATIENT
07/01/2011 Yes
99342 HOME VISIT NEW PATIENT
07/01/2011 Yes
99343 HOME VISIT NEW PATIENT
07/01/2011 Yes
99344 HOME VISIT NEW PATIENT
07/01/2011 Yes
99345 HOME VISIT NEW PATIENT
07/01/2011 Yes
99347 HOME VISIT EST PATIENT
07/01/2011 Yes
99348 HOME VISIT EST PATIENT
07/01/2011 Yes
99349 HOME VISIT EST PATIENT
07/01/2011 Yes
99350 HOME VISIT EST PATIENT
07/01/2011 Yes
99466 PED CRIT CARE TRANSPORT
07/01/2011 Yes
99468 NEONATE CRIT CARE INITIAL
07/01/2011 Yes
99469 NEONATE CRIT CARE SUBSQ
07/01/2011 Yes
99471 PED CRITICAL CARE INITIAL
07/01/2011 Yes
99472 PED CRITICAL CARE SUBSQ
07/01/2011 Yes
99475 PED CRIT CARE AGE 2-5 INIT
07/01/2011 Yes
99476 PED CRIT CARE AGE 2-5 SUBSQ
07/01/2011 Yes
99477 INIT DAY HOSP NEONATE CARE
07/01/2011 Yes
99478 IC LBW INF < 1500 GM SUBSQ
07/01/2011 Yes
99479 IC LBW INF 1500-2500 G SUBSQ
07/01/2011 Yes
99480 IC INF PBW 2501-5000 G SUBSQ
07/01/2011 Yes
99483 ASSMT & CARE PLN PT COG IMP
01/01/2018 Yes
99485 SUPRV INTERFACILTY TRANSPORT
01/01/2013 Yes
99497 ADVNCD CARE PLAN 30 MIN
01/01/2016 Yes
G0380 Lev 1 hosp type b ed visit
07/01/2011 Yes
G0381 Lev 2 hosp type b ed visit
07/01/2011 Yes
G0382 Lev 3 hosp type b ed visit
07/01/2011 Yes
G0383 Lev 4 hosp type b ed visit
07/01/2011 Yes
G0384 Lev 5 hosp type b ed visit
07/01/2011 Yes
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G0471 Ven blood coll snf/hha
07/01/2015 Yes
(1) These codes will be denied when submitted for payment on the same date of service as Q2043.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for Q2043
Denied Codes (1) Effective Modifier
Accepted (2)
36522 PHOTOPHERESIS 07/01/2011 Yes
(1) These codes will be denied when submitted for payment on the same date of service as Q2043.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for Q2043


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   Q2043 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
PARTHIV MEHTA -GLENVIEW,IL 75
BENJAMIN LOWENTRITT -BALTIMORE,MD 56
NICHOLAS VOGELZANG -LAS VEGAS,NV 52
DAVID GOLDSTEIN -BALTIMORE,MD 51
GARY KIRSH -BLUE ASH,OH 48

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for Q2043*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2016: 5,695
Total Services Denied 2016: 1,996 (35.0%)
National Charges Submitted 2016: $257,052,311.00
National Charges Allowed 2016: $139,113,497.73
National Average (No Modifier) Fee Submitted 2016: $44616.82
National Average (No Modifier) Fee Allowed 2016: $37606.90


Top 5 Performing Specialties 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Hematology/oncology
(eff 5/92)
2,635 46.3% $29546.09 1,722 65.4%
Urology 2,241 39.4% $54424.95 146 6.5%
Medical oncology
(eff 5/92)
344 6.0% $71977.63 66 19.2%
Radiation oncology
(eff 5/92)
196 3.4% $85056.81 12 6.1%
Physician assistant
(eff 5/92)
69 1.2% $47805.86 2 2.9%

Top 5 Places of Service 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 5,695 100.0% $45136.49 1,996 35.0%

Top 5 Modifiers Submitted 2016 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 5,626 98.8% $44616.82 1,982 35.2%
GA - Advanced Beneficiary Notice (ABN) on File 47 0.8% $85925.40 9 19.1%
Q6 - Physician Services 9 0.2% $98000.00 0 0.0%
Q1 8 0.1% $92312.50 2 25.0%
GZ - Service Expected to be Denied as Not Reasonable and Necessary 3 0.1% $96937.00 3 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

CMS Transmittals Referencing "Q2043"
Issue DateTransmittalTitle
2018-01-12 R3950CP 2018 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
07/20/2018 07:11:15 54.166.228.35

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