| HCPCS Code: |
Q0090 |
| Long Description: |
Levonorgestrel-releasing intrauterine contraceptive system, (skyla), 13.5 mg |
| Short Description: |
Skyla 13.5mg |
| Pricing Indicator 1: |
00 (Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)) |
| Multiple Pricing Code: |
9 (Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is 99)) |
| Statute Number: |
1862a1 |
| Cross Reference Code 1: |
J7301 |
| Coverage Code: |
S (Non-covered by Medicare statute) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
P6C (Minor procedures - other (Medicare fee schedule)) |
| Type of Service Code 1: |
9 (Other medical items or services) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-07-2013 |
| Action Effective Date: |
01-01-2014 |
| Termination Date: |
31-12-2013 |
| Action Code: |
D (Discontinue procedure or modifier code) |
