- Short DescriptionPlt, aph/pher, l/r, cmv-neg
- HCPCS Coverage CodeD = Special coverage instructions apply
- HCPCS Action CodeN = No maintenance for this code
- HCPCS Action Effective DateJan 01, 2004
- HCPCS Code Added DateJan 01, 2004
- HCPCS Pricing Indicator Code52 = Reasonable charge
- HCPCS Multiple Pricing Indicator CodeA = Not applicable as HCPCS priced under one methodology
- HCPCS Cross Reference Code
- HCPCS Type Of Service Code9
- HCPCS Anesthesia Base Unit Quantity