Table of content for "Lumason contrast agent" (HCPCS C9457)
General information on the “C9457” code
HCPCS Code: C9457
Long Description: Injection, sulfur hexafluoride lipid microsphere, per ml
Short Description: Lumason contrast agent
Original information is taken from C9457 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: Q9950 ;
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Berenson-Eggers Type of Service (BETOS): O1E – Other drugs
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: 20151001
Code Effective Date: 20160101
Termination Date: 20151231
Action Code: N – No maintenance for this code