- Short DescriptionOne-way allow prorated miles
- HCPCS Coverage CodeD = Special coverage instructions apply
- HCPCS Action CodeN = No maintenance for this code
- HCPCS Action Effective DateJan 01, 1992
- HCPCS Code Added DateJan 01, 1987
- HCPCS Pricing Indicator Code22 = Price established by carriers (e.G., gap-fills, carrier established panels)
- HCPCS Multiple Pricing Indicator CodeA = Not applicable as HCPCS priced under one methodology
- HCPCS Cross Reference Code
- HCPCS Type Of Service Code5
- HCPCS Anesthesia Base Unit Quantity
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