| HCPCS Code: |
J1452 |
| Long Description: |
Injection, fomivirsen sodium, intraocular, 1.65 mg |
| Short Description: |
Intraocular fomivirsen na |
| Pricing Indicator 1: |
51 (Drugs) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| MCM Reference Section Number 1: |
2049.3 |
| Statute Number: |
|
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
O1E (Other drugs) |
| Type of Service Code 1: |
1 (Medical care) |
| Type of Service Code 2: |
P (Lump sum purchase of DME, prosthetics, orthotics) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2001 |
| Action Effective Date: |
01-01-2014 |
| Action Code: |
P (Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)) |
