| HCPCS Code: |
C1204 |
| Long Description: |
Technetium tc 99m tilmanocept, diagnostic, up to 0.5 millicuries |
| Short Description: |
Tc 99m tilmanocept |
| Pricing Indicator 1: |
53 (Statute) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Statute Number: |
1833(t) |
| Cross Reference Code 1: |
A9520 |
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
I1E (Standard imaging - nuclear medicine) |
| Type of Service Code 1: |
4 (Diagnostic radiology) |
| Type of Service Code 2: |
F (Ambulatory surgical center (facility usage for surgical services)) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-10-2013 |
| Action Effective Date: |
01-01-2014 |
| Termination Date: |
31-12-2013 |
| Action Code: |
D (Discontinue procedure or modifier code) |
