Table of content for "Tc 99m tilmanocept" (HCPCS C1204)
General information on the “C1204” code
HCPCS Code: C1204
Long Description: Technetium tc 99m tilmanocept, diagnostic, up to 0.5 millicuries
Short Description: Tc 99m tilmanocept
Original information is taken from C1204 page
Pricing indicators
Pricing Indicator Code 1: 53 – Statute
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Statute Number: 1833(t)
Cross Reference Code 1: A9520 ;
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Berenson-Eggers Type of Service (BETOS): I1E – Standard imaging - nuclear medicine
Type Of Service 1: 4 – Diagnostic radiology
Type Of Service 2: F – Ambulatory surgical center (facility usage for surgical services)
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20131001
Code Effective Date: 20140101
Termination Date: 20131231
Action Code: N – No maintenance for this code