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* Available in Professional Version Only

Note:  D Codes (ADA CDT dental codes) are not included in this database.  See CDT  for more information.

HCPCS_Multiple_Pricing_Indicator

9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99') Noncovered by Medicare

 A = Not applicable as HCPCS priced under one methodology Carrier Discretion

 B = Professional component of HCPCS priced using RVU's, while technical component and global service priced by Medicare part B carriers

 C = Physician interpretation of clinical lab service is priced under physician fee schedule using RVU's, while pricing of lab service is paid under clinical lab fee schedule

 D = Service performed by physician is priced under physician fee schedule using RVU's, while service performed by clinical psychologist is priced under clinical psychologist fee schedule (not applicable as of January 1, 1998)

 E = Service performed by physician is priced under physician fee schedule using RVU's, service performed by clinical psychologist is priced under clinical psychologist's fee schedule and service performed by clinical social worker is priced under clinical social worker fee schedule (not applicable as of January 1, 1998)

 F = Service performed by physician is priced under physician fee schedule by carriers, service performed by clinical psychologist is priced under clinical psychologist's fee schedule and service performed by clinical social worker is priced under clinical social worker fee schedule (not applicable as of January 1, 1998)

 G = Clinical lab service priced under reasonable charge when service is submitted on claim with blood products, while service is priced under clinical lab fee schedule when there are no blood products on claim.

HCPCS_Pricing_Indicator

00, 11, 12, 13, 21, 22, 31, 32, 33, 34, 35, 36, 37, 38, 39, 45, 46, 51, 52, 53, 54, 55, 56, 57, 99

00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.) Physician Fee Schedule And Non-Physician Practitioners Linked To The Physician Fee Schedule

11 = Price established using national rvu's

12 = Price established using national anesthesia base units

13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion) Clinical Lab Fee Schedule

21 = Price subject to national limitation amount

22 = Price established by carriers (e.g., gap-fills, carrier established panels) Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings

31 = Frequently serviced DME (price subject to floors and ceilings)

32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)

33 = Oxygen and oxygen equipment (price subject to floors and ceilings)

34 = DME supplies (price subject to floors and ceilings)

35 = Surgical dressings (price subject to floors and ceilings)

36 = Capped rental DME (price subject to floors and ceilings)

37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)

38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)

39 = Parenteral and Enteral Nutrition

45 = Customized DME items

46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)

51 = Drugs

52 = Reasonable charge

53 = Statute

54 = Vaccinations

55 = Priced by carriers under clinical psychologist fee schedule (not applicable as of January 1, 1998)

56 = Priced by carriers under clinical social worker fee schedule (not applicable as of January 1, 1998)

57 = Other carrier priced

99 = Value not established

ASC Payment Indicator Definition

A2, D5, F4, G2, H2, H8, J7, J8, K2, K7, L1, L6, N1, P2, P3, R2, Z2, Z3