Transcription of MEDICAL SUPPLY FEE SCHEDULE Effective …
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MEDICAL SUPPLY FEE SCHEDULE Effective …
CodeModifier-StatusPADescriptionMin AgeMax AgeBegin DateEnd DateMax UnitsFeeA4206SC-Fee on FileNoSYRINGE WITH NEEDLE, STERILE, 1 CC OR LESS, EACH099910/01/200312/31 on FileNoSYRINGE WITH NEEDLE STERILE 3 CC EACH099910/01/200312/31 on FileNoSYRINGE WITH NEEDLE STERILE 5 CC OR GREATER EACH099910/01/200312/31 PricingNoNON-CORING NEEDLE OR STYLET WITH OR WTIHOUT CATHETER099901/01/200912/31 PricingNoSYRINGE STERILE 20 CC OR GREATER EACH099901/01/200912/31 PricingNoNEEDLE, STERILE, ANY SIZE, EACH099901/01/200912/31 on FileNoSTERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML099907/01/201512/31 on FileNoSTERILE WATER/SALINE, 500 ML099907/01/201712/31 on FileNoSUPPLIES FOR MAINTENANCE OF NON-INSULIN DRUG INFUSION CATHETER, PER WEEK (LIST DRUGS SEPARATELY)099907/01/201712/31
PA: Description Min Age Max Age Begin Date End Date Max Units Fee A4206 SC-Fee on File; No SYRINGE WITH NEEDLE, STERILE, 1 CC OR LESS, EACH 0; 999 10/01…
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