| HCPCS Code: |
C9406 |
| Long Description: |
Iodine i-123 ioflupane, diagnostic, per study dose, up to 5 millicuries |
| Short Description: |
Dx i-123 ioflupane, per dose |
| 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: |
A9584 |
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
0093 |
| Berenson-Eggers Type of Service (BETOS) Code: |
O1E (Other drugs) |
| Type of Service Code 1: |
4 (Diagnostic radiology) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-07-2011 |
| Action Effective Date: |
01-01-2012 |
| Termination Date: |
31-12-2011 |
| Action Code: |
N (No maintenance for this code) |
