Table of content for "Mri w/o cont, breast, uni" (HCPCS C8904)
General information on the “C8904” code
HCPCS Code: C8904
Long Description: Magnetic resonance imaging without contrast, breast; unilateral
Short Description: Mri w/o cont, breast, uni
Original information is taken from C8904 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)(2)
Cross Reference Code 1: 77046 ;
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Berenson-Eggers Type of Service (BETOS): I2D – Advanced imaging - MRI/MRA: other
Type Of Service 1: 4 – Diagnostic radiology
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20011001
Code Effective Date: 20190101
Termination Date: 20181231
Action Code: N – No maintenance for this code