| Short Description | Refused to participate |
| HCPCS Coverage Code | C - Carrier judgment |
| HCPCS Action Code | N - No maintenance for this code |
| HCPCS Action Effective Date | January 01, 2017 |
| HCPCS Code Added Date | January 01, 2017 |
| 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 Coverage Issues Manual Reference Section Number | |
| HCPCS Type Of Service Code | 1 - Medical care |
| HCPCS Anesthesia Base Unit Quantity | 0 |
