E1629

Short Description

• Tablo for dialysis service

HCPCS Coverage Code

• C = Carrier judgment

HCPCS Action Code

• N = No maintenance for this code

HCPCS Action Effective Date

• January 01, 2022

HCPCS Code Added Date

• January 01, 2022

HCPCS Pricing Indicator Code

• 00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)

HCPCS Multiple Pricing Indicator 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’)

HCPCS Type Of Service Code

• L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)

HCPCS Anesthesia Base Unit Quantity

• 0