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HCPCS B4172

Parenteral sol amino acid 5.

Historical IOCE Data

v20.2.27 – v27.1.0 (2019-07-01 to 2036-03-31)

Description

"Parenteral sol amino acid 5."

Core Attributes

Default APC
00000
Status Indicator? Default status indicator assigned to this CPT/HCPCS code
Y
Payment Indicator? Default payment indicator assigned to this CPT/HCPCS code
3

Demographics & Restrictions

Age Range? Valid age range: Neonatal 0-0, Pediatric 0-17, Adult 18-124
0 – 124

Processing Rules & Flags

Trauma & Critical Care 3

Trauma Revenue Code ? Revenue code 068x is required for trauma response critical care services (Edit 76). Values: 0 = not applicable 1 = applicable
0
Trauma Critical Care ? Critical care services required to be reported with trauma response service (Edit 76). Values: 0 = not applicable 1 = applicable
0
Critical Care Ancillary ? Critical care ancillary service. Values: 0 = not applicable 1 = applicable
0

Procedures & Devices 10

Device ? Device for a device-dependent procedure (Edit 92). Values: 0 = not applicable 1 = applicable
0
Bypass E92 Modifier ? Device procedure may bypass edit 92 if the appropriate modifier is present on the line. Values: 0 = not applicable 1 = applicable
0
Has Dev Req Proc ? Device CPT/HCPCS that require a surgical implantation procedure code to be reported (Edit 77), v58. Values: 0 = not applicable 1 = applicable
0
Separate Procedure ? Separate inpatient procedure (Edit 45). Values: 0 = not applicable 1 = applicable
0
Dev Proc Bypass ? Device codes that bypass edit 71 and 77 for dates prior to 8/13/2013. Values: 0 = not applicable 1 = applicable
0
Has Device Pair1 ? Surgical implantation procedure that requires a device CPT/HCPCS to be reported (Edit 71), prior to v58. Values: 0 = not applicable 1 = applicable
0
Has Device Pair2 ? Surgical implantation procedure that may require a second device HCPCS to be reported (Edit 71), prior to v58. Values: 0 = not applicable 1 = applicable
0
Terminated Device Procedure ? Device intensive procedure may be subject to payment offset/credit for the following conditions: terminated procedure reported with modifier 73 or procedures subject to full or partial device credit due to the presence of condition code 49, 50 or 53. Values: 0 = not applicable 1 = applicable
0
Device Dependent Procedure ? Device required for specified procedure (edit 135). Values: 0 = not applicable 1 = applicable
0
Device Procedure ? Device-dependent procedure (Edit 92). Values: 0 = not applicable 1 = applicable
0

Add-on Codes 6

Addon Type3 ? Type III add-on code (Edit 108). Values: 0 = not applicable 1 = applicable
0
Addon Drug Admin ? Drug administration add-on code (Edit 106). Values: 0 = not applicable 1 = applicable
0
Addon Covid Lab ? Covid-19 laboratory add-on code requires primary code (Edit 115). Discontinued effective v24.1
0
Addon Saas ? CPT/HCPCS codes identified as software-as-a-service addons requiring a primary software-as-a-service code to be present (Edit 106). Values: 0 = not applicable 1 = applicable
0
Addon Type1 ? Type I add-on code (Edit 106). Values: 0 = not applicable 1 = applicable
0
Addon Type2 ? Type II add-on code (Edit 107). Values: 0 = not applicable 1 = applicable
0

FQHC & RHC 10

Fqhc Dcaps ? Drugs Covered as Additional Preventive Services for FQHCs. Values: 0 = not applicable to code 1 = applicable to code
0
Fqhc Non Packaged Preventive ? Preventive services that are not packaged for FQHC/RHC. Values: 0 = not applicable to code 1 = applicable to code
0
Fqhc Preventive ? FQHC PPS preventive service for bill type 77x. Values: 0 = not applicable 1 = applicable
0
Fqhc Flu Ppv ? FQHC PPS influenza/PPV vaccine service for bill type 77x (discontinued effective v26.0)
0
Fqhc Non Covered ? FQHC PPS non-covered service for bill type 77x. Values: 0 = not applicable 1 = applicable
0
Fqhc Addon ? FQHC PPS mental health add-on service requires primary procedure code for bill type 77x. Values: 0 = not applicable 1 = applicable
0
Fqhc Primary ? FQHC PPS primary procedure service code not reported with mental health add-on service code for bill type 77x. Values: 0 = not applicable 1 = applicable
0
Fqhc Chronic Care ? FQHC Chronic Care Management code. Values: 0 = not applicable 1 = applicable
0
Rhc Modifier Conflict ? Not eligible for the all-inclusive rate under Rural Health Clinic (RHC). Values: 0 = not applicable 1 = applicable
0
Bypass E72 Fqhc Rhc ? Not subject to edit 72 under FQHC and RHC. Values: 0 = not applicable 1 = applicable
0

Skin Substitutes 7

Skin Substitute Sg Lo ? Low-cost skin substitute procedure (Edit 87) (v15.0 - v26.3) Values: 0 = not applicable to code 1 = applicable to code
0
Skin Substitute Lo ? Low-cost skin substitute product (Edit 87) (v15.0 - v26.3) Values: 0 = not applicable to code 1 = applicable to code
0
Skin Substitute Application Procedure ? Skin substitute application procedure (Edit 87). Values: 0 = not applicable to code 1 = applicable to code
0
Skin Substitute Sg Hi ? High-cost skin substitute procedure (Edit 87) (v15.0 - v26.3) Values: 0 = not applicable to code 1 = applicable to code
0
Skin Substitute Hi ? High-cost skin substitute product (Edit 87) (v15.0 - v26.3) Values: 0 = not applicable to code 1 = applicable to code
0
Skin Substitute Sg ? Skin substitute application procedure (v13.0-v14.3). Values: 0 = not applicable 1 = applicable
0
Skin Substitute ? Skin substitute product (v13.0-v14.3). Values: 0 = not applicable 1 = applicable
0

Drugs & Biologicals 7

Biosimilar ? Biosimilar code required to be reported with an applicable manufacturer modifier. Values: 0 = not applicable 1 = applicable
0
Bundled In Biological ? Cost of service bundled into cost of drug or biological (Edit 111). Values: 0 = not applicable 1 = applicable
0
Unclassified Drug ? Unclassified Drug (Edit 66). Values: 0 = not applicable 1 = applicable
No
Opioid Treatment Program ? Code only approved for the opioid treatment program (Edit 116). Values: 0 = not applicable to code 1 = applicable to code
0
Opioid Use Disorder Model ? Identifies HCPCS codes flagged as applicable to opioid use disorder model logic. Values: 0 = not applicable 1 = applicable
0
Vaccine ? Vaccine services that may be paid for Home Health Agency (HHA) or Hospice claims under OPPS. Values: 0 = not applicable 1 = applicable
0
Antigen ? Antigens for allergen immunotherapy services that may be paid for Home Health Agency (HHA) or Hospice claims under OPPS. Values: 0 = not applicable 1 = applicable
0

Billing & Coverage 10

Questionable ? Questionable service (Edit 12). Values: 0 = not applicable 1 = applicable
0
Not Recognized Mcare ? Code not recognized by Medicare for outpatient claims; alternate code for same service may be available (Edit 28)
0
Not Recognized Opps ? Not recognized by OPPS (Edit 62). Values: 0 = not applicable 1 = applicable
0
Non Covered ? Non-covered service (Edit 9). Values: 0 = not applicable 1 = applicable
0
Information Only ? Information-only service (Edit 112). Values: 0 = not applicable 1 = applicable
0
Non Reportable Site ? C-HCPCS codes only reportable for OPPS claims (Edit 55). Values: 0 = not applicable 1 = applicable
0
Statutory Exclusion ? Statutory exclusion (Edit 50). Values: 0 = not applicable 1 = applicable
0
Dmerc Billable Only ? Billable to Durable Medical Equipment Regional Carrier (DMERC) only (Edit 61). Values: 0 = not applicable 1 = applicable
1
Non Billable Mac ? Not billable to MAC (Edit 72). Values: 0 = not applicable 1 = applicable
0
Part B Billable ? Identifies HCPCS codes allowed to be reported for Part B Inpatient Claims (BT 012x) with or without a Part B Billable Inpatient revenue code. (Bypass Edit 127) Values: 0 = not applicable to code 1 = applicable to code
0

Packaging 6

Stv Packaged ? Code packaged when status indicator S, T, or V procedure present. Values: 0 = not applicable 1 = applicable
0
T Packaged ? Code packaged when status indicator T procedure present. Values: 0 = not applicable 1 = applicable
0
Passthrough Device ? Pass-through device subject to payment offset for device procedure logic. Values: 0 = not applicable 1 = applicable
0
Passthrough Skin Product ? Pass-through skin substitute product subject to payment offset for skin substitute implantation procedure logic. Values: 0 = not applicable 1 = applicable
0
Capc Exclusion ? Code excluded from comprehensive APC packaging. Values: 0 = not applicable 1 = applicable
0
Capc Srs Plan And Prep ? Stereotactic Radiosurgery planning and preparation procedure. Values: 0 = not applicable 1 = applicable
0

Specialty & Other 13

Lab Service ? Non-packaged laboratory service for bill type 14x (v62). Values: 0 = not applicable 1 = applicable
0
Colorectal ? Colorectal CPT/HCPCS code (Edit 120). Values: 0 = not applicable 1 = applicable
0
Splint ? Splint application services that may be paid for Home Health Agency (HHA) or Hospice claims under OPPS. Values: 0 = not applicable 1 = applicable
0
Cast ? Cast application services that may be paid for Home Health Agency (HHA) or Hospice claims under OPPS. Values: 0 = not applicable 1 = applicable
0
Cornea Transplant ? Code may be paired with cornea tissue processing code (Edit 93). Values: 0 = not applicable 1 = applicable
0
Negative Pressure Wound Therapy ? NPWT services separately payable on Home Health Agency (HHA) claims with bill type 34x. Values: 0 = not applicable 1 = applicable
0
Cornea Tissue Processing ? Cornea tissue processing code (Edit 93). Values: 0 = not applicable 1 = applicable
0
Advanced Care Planning ? Advanced care planning code. Values: 0 = not applicable 1 = applicable
0
Telehealth ? Identifies HCPCS codes flagged as reportable for Telehealth (Edit 126) Values: 0 = not applicable to code 1 = applicable to code
0
Annual Wellness Visit ? Medicare annual wellness visit code. Values: 0 = not applicable 1 = applicable
0
Educational ? Education and Training HCPCS (Edit 35). Values: 0 = not applicable 1 = applicable
0
Allogeneic Transplant ? Allogeneic transplant procedure (Edit 100). Values: 0 = not applicable 1 = applicable
0
Sdoh Risk Assessment ? CPT/HCPCS codes identified as social determinant of health codes. Values: 0 = not applicable to code 1 = applicable to code
0

Bilateral & Laterality 3

Bilateral Conditional ? Conditional bilateral code from Medicare physician fee schedule. Values: 0 = not applicable 1 = applicable
0
Bilateral Independent ? Independent bilateral code from Medicare physician fee schedule. Values: 0 = not applicable 1 = applicable
0
Bilateral Inherent ? Inherent bilateral code from Medicare physician fee schedule. Values: 0 = not applicable 1 = applicable
0

Payment & Deductibles 7

Coinsurance Deductible Waiver Eligible ? Eligible for coinsurance deductible waiver if reported with modifier CS. Items that are not flagged as being eligible for coinsurance deductible waiver should not be reported with modifier CS (Edit 114). Values: 0 = not applicable 1 = applicable
No
Deductible Na ? Deductible is not applicable for CPT/HCPCS. Values: 0 = not applicable 1 = applicable
0
Deductible Coins Na ? Deductible and Coinsurance are not applicable for CPT/HCPCS. Values: 0 = not applicable 1 = applicable
0
Coins Na ? Coinsurance not applicable for CPT/HCPCS. Values: 0 = not applicable 1 = applicable
0
Token Charge Only ? Radiolabeled product provided during an inpatient stay under Medicare Part B that may have a line item charge reported as $1.01 or less. Values: 0 = not applicable 1 = applicable
0
Override Section603 ? Not subject to payment reduction under Section 603 requirements. Values: 0 = not applicable 1 = applicable
0
Section603 Exclusion ? Identifies HCPCS codes that are on the section 603 exclusion list. Values: 0 = not applicable to code 1 = applicable to code
0

NCCI Edits 2

Ncci Code1 ? Code 1 of code pair subject to NCCI PTP editing. Values: 0 = not applicable 1 = applicable
Yes — View Pairs →
Ncci Code2 ? Code 2 of code pair subject to NCCI PTP editing. Values: 0 = not applicable 1 = applicable
Yes — View Pairs →

Imaging & Radiology 9

Radio Pharm ? Radiolabeled product(s) required for nuclear medicine procedure, prior to v54. Values: 0 = not applicable 1 = applicable
No
Nuclear Med ? Nuclear medicine procedure requires diagnostic radiopharmaceutical, prior to v54. Values: 0 = not applicable 1 = applicable
No
Imrt ? Identifies HCPCS codes that are imrt service(s). Values: 0 = not applicable to code 1 = applicable to code
0
Passthrough Radiopharm ? Pass-through radiopharmaceutical subject to payment offset for nuclear medicine procedure logic. Values: 0 = not applicable 1 = applicable
0
Passthrough Contrast ? Pass-through contrast agent subject to payment offset for radiological procedure logic. Values: 0 = not applicable 1 = applicable
0
Passthrough Stress Agent ? Pass-through pharmacologic stress agent subject to payment offset for myocardial perfusion imaging procedure logic. Values: 0 = not applicable 1 = applicable
0
Non Standard Ct Scan ? Code may be reported with modifier CT for non-standard NEMA equipment. Values: 0 = not applicable 1 = applicable
0
Film Xray ? Film x-ray code subject to payment reduction when reported with applicable radiological modifier FX or FY. Values: 0 = not applicable 1 = applicable
0
Radiopharm Exceeds Threshold ? Identifies passthrough and non-passthrough radiopharmaceutical HCPCS that have a per day cost that exceeds a packaging threshold (defined in Data_Radiopharm_Packaging_Threshold). Radiopharmaceuticals that exceed the packaging threshold have coinsuranse waived; those that do not exceed the threshold are coinsurance not applicable. Values: 0 = not applicable to code 1 = applicable to code
0

Mid-Quarter & Dates 5

Mid Quarter Date Edit ? The mid-quarter date edit returned when conditions present on claim. Values: 0 = not applicable 67 = Service provided prior to FDA approval 68 = Service provided prior to date of NCD approval 69 = Service provided outside approval period 83 = Service provided on or after effective date of NCD noncoverage 110 = Service provided prior to initial marketing dateo 124 = HCPCS reported after CMS termination date 134 = Service provided outside designated approval period
0
Cms Mid Quarter Termination ? CPT/HCPCS codes subject to edit 124 if reported on or after the CMS mid-quarter termination date. Values: 0 = not applicable 1 = applicable
0
Date Approved ? The effective mid-quarter date of approval for FDA, National Coverage Determination (NCD), or initial marketing date. Values: 0 = not applicable YYYYMMDD = approval date for code
0
Cms Mid Quarter Termination Bypass ? CPT/HCPCS not subject to CAPC packaging exclusion or deductible/coinsurance waiver on or after the CMS mid-quarter termination date. Values: 0 = not applicable 1 = applicable
0
Date Terminated ? The mid-quarter date when a code approval period becomes inactive. Values: 0 = not applicable YYYYMMDD = termination date for code
0

Therapy & Mental Health 19

Remote Mental Health ? CPT/HCPCS codes identified as remote_mental_health service that packages into partial hospitalization and mental health composites. Values: 0 = not applicable 1 = applicable
0
Therapy Conditionally Paid ? Therapy services conditionally paid under OPPS. Values: 0 = not applicable 1 = applicable
0
Ph Primary ? Primary partial hospitalization program (PHP) service (e.g. psychotherapy) subject to the partial hospitalization program logic. Values: 0 = not applicable 1 = applicable
0
Activity Therapy ? Activity therapy service not payable outside of a partial hospitalization program (PHP). Values: 0 = not applicable 1 = applicable
0
Ph Service ? Services applicable to the partial hospitalization program. Values: 0 = not applicable 1 = applicable
0
Remote Mental Health Addon ? CPT/HCPCS codes identified as remote mental health add-on codes requiring a primary remote mental health code to be present (Edit 106). Values: 0 = not applicable to code 1 = applicable to code
0
Occupational Therapy ? Occupational therapy service only billable on partial hospitalization claims (PHP). Values: 0 = not applicable 1 = applicable
0
Daily Mental Health ? Mental health services that count towards the daily mental health service total. Values: 0 = not applicable 1 = applicable
0
Iop Primary ? CPT/HCPCS codes identified as iop_primary for IOP composite processing. Values: 0 = not applicable 1 = applicable
0
Mh Not Ph ? Mental health service that is not payable under the partial hospitalization program (PHP) (Edit 80). Values: 0 = not applicable 1 = applicable
0
Iop Service ? CPT/HCPCS codes identified as iop_service for IOP composite processing. Values: 0 = not applicable 1 = applicable
0
Ph Not Mh ? Partial hospitalization service that is not payable on a mental health claim (Edit 81). Values: 0 = not applicable 1 = applicable
0
Mh Not Iop ? CPT/HCPCS codes identified as mh_not_iop for IOP composite processing. Values: 0 = not applicable 1 = applicable
0
Ph Duration ? Numeric value representing the duration of a partial hospitalization program (PHP) service that counts towards the weekly requirements for the partial hospitalization program (PHP) (Edit 95). Values: 0 = 1 hour or not applicable 1 = 0.25 hour 2 = 0.5 hour 3 = 0.75 hour
0
Iop Not Mh ? CPT/HCPCS codes identified as iop_not_mh for IOP composite processing. Values: 0 = not applicable 1 = applicable
0
Ph Addon ? Partial hospitalization program (PHP) add-on codes excluded from the PHP daily count and subject to editing (Edit 84). Values: 0 = not applicable 1 = applicable
0
Iop Duration ? CPT/HCPCS codes identified as iop_duration for IOP composite processing. Values: 0 = 1 hour 1 = 15 minutes 2 = 30 minutes 3 = 45 minutes
0
Iop Addon ? CPT/HCPCS codes identified as iop_addon for IOP composite processing. Values: 0 = not applicable 1 = applicable
0
Php Iop Reportable ? These services are reportable for PHP or IOP claims but do not count towards the PHP or IOP day, SI is set to N. Values: 0 = not applicable 1 = applicable
0

Blood Services 5

Packed Red Cells ? Packed red blood cells reported with revenue code 381 (Edit 79). Values: 0 = not applicable 1 = applicable
0
Blood Service ? Blood transfusion or exchange (Edit 43). Values: 0 = not applicable 1 = applicable
0
Blood Product ? Blood product (Edit 43). Values: 0 = not applicable 1 = applicable
0
Whole Blood ? Whole blood reported with revenue code 382 (Edit 79). Values: 0 = not applicable 1 = applicable
0
Bypass E99 ? Blood clotting factor excluded from edit (Edit 99). Values: 0 = not applicable 1 = applicable
0

Observation & ER 4

Observation ? Observation CPT/HCPCS code requires revenue code 762 (Edit 44). Values: 0 = not applicable 1 = applicable
0
Observation Hourly ? Observation code requires the number of observation hours reported in the units of service field. Values: 0 = not applicable 1 = applicable
0
Observation Direct Admit ? Observation code for direct admission or referral to hospital observation. Values: 0 = not applicable 1 = applicable
0
Observation Hospital Only ? Observation code can only be reported with bill type 13x or 85x (Edit 53). Values: 0 = not applicable 1 = applicable
0

NCCI Code Pair Edits

B4172 has 9 NCCI Correct Coding Initiative (CCI) code pair edits on record.

View All CCI Pairs →

Frequently Asked Questions

What is the Status Indicator for HCPCS code B4172?

The Medicare status indicator for HCPCS/CPT code B4172 is currently Y. Status indicators are used in the Outpatient Prospective Payment System (OPPS) to determine how a service or procedure is paid.

Are there age or sex restrictions for HCPCS code B4172?

For code B4172, the valid age range is 0 to 124. There are no gender-based restrictions.

Are there NCCI edits associated with code B4172?

Yes, code B4172 has 9 NCCI Correct Coding Initiative (CCI) code pair edits on record. View Edit Pairs →

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