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| HCPCS |
Seq Num |
RIC |
Long Description |
Short Description |
PI1 | PI2 | PI3 | PI4 | MPI | CIM1 | CIM2 | CIM3 | MCM1 | MCM2 | MCM3 | Statute |
Lab Cert1 |
Lab Cert2 |
Lab Cert3 |
Lab Cert4 |
Lab Cert5 |
Lab Cert6 |
Lab Cert7 |
Lab Cert8 |
X-Ref1 | X-Ref2 | X-Ref3 | X-Ref4 | X-Ref5 | Coverage | ASC Pay Grp |
ASC_Pay_Grp Eff_Date |
Mog Pay Grp |
Mog Pay Ind |
Mog Eff Date |
Proc Note |
BETOS | FILLER | TOS1 | TOS2 | TOS3 | TOS4 | TOS5 |
Anest Base Units |
Code Add Date |
Action Eff Date |
Term Date |
Action Code |
| A6196 | 00100 | 3 | "ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ." | Alginate dressing <=16 sq in | 35 | A | 2079 | D | D1A | S | 19970101 | 20090101 | C | |||||||||||||||||||||||||||||||||||
| A6197 | 00100 | 3 | "ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE" | Alginate drsg >16 <=48 sq in | 35 | A | 2079 | D | D1A | S | 19970101 | 20090101 | C | |||||||||||||||||||||||||||||||||||
| A6198 | 00100 | 3 | "ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE" | alginate dressing > 48 sq in | 46 | A | 2079 | D | D1A | S | 19970101 | 20090101 | C | |||||||||||||||||||||||||||||||||||
| A6199 | 00100 | 3 | "ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, STERILE, PER 6 INCHES" | Alginate drsg wound filler | 35 | A | 2079 | D | D1A | S | 19970101 | 20090101 | C | |||||||||||||||||||||||||||||||||||
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