Type of Service (TOS) Indicator F: Ambulatory Surgical Center (Facility Usage for Surgical Services)
Special Considerations/Exceptions
Surgical services billed for dates of service through December 31, 2007, containing the ASC facility service modifier SG must be reported as TOS F. Effective for services on or after January 1, 2008, the SG modifier is no longer applicable for Medicare services. ASC providers should discontinue applying the SG modifier on ASC facility claims. The indicator 'F' does not appear in the TOS table because its use depends upon claims submitted with POS 24 (ASC Facility) from an ASC (specialty 49). This became effective for dates of service January 1, 2008 and after.
HCPCS codes | ||
| Code | Description | |
|---|---|---|
| C1748 | Endoscope, single-use (i.e. disposable), upper gi, imaging/illumination device (insertable) | |
| C1849 | Skin substitute, synthetic, resorbable, per square centimeter | |
| C9033 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | |
| C9034 | Injection, dexamethasone 9%, intraocular, 1 mcg | |
| C9040 | Injection, fremanezumab-vfrm, 1mg | |
| C9041 | Injection, coagulation factor xa (recombinant), inactivated (andexxa), 10 mg | |
| C9042 | Injection, bendamustine hcl (belrapzo), 1 mg | |
| C9043 | Injection, levoleucovorin, 1 mg | |
| C9044 | Injection, cemiplimab-rwlc, 1 mg | |
| C9045 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg | |
| C9046 | Cocaine hydrochloride nasal solution for topical administration, 1 mg | |
| C9047 | Injection, caplacizumab-yhdp, 1 mg | |
| C9048 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | |
| C9049 | Injection, tagraxofusp-erzs, 10 mcg | |
| C9050 | Injection, emapalumab-lzsg, 1 mg | |
| C9051 | Injection, omadacycline, 1 mg | |
| C9052 | Injection, ravulizumab-cwvz, 10 mg | |
| C9053 | Injection, crizanlizumab-tmca, 1 mg | |
| C9055 | Injection, brexanolone, 1mg | |
| C9056 | Injection, givosiran, 0.5 mg | |
| C9057 | Injection, cetirizine hydrochloride, 1 mg | |
| C9058 | Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo) 0.5 mg | |
| C9059 | Injection, meloxicam, 1 mg | |
| C9060 | Fluoroestradiol f18, diagnostic, 1 mci | |
| C9061 | Injection, teprotumumab-trbw, 10 mg | |
| C9062 | Injection, daratumumab 10 mg and hyaluronidase-fihj | |
| C9063 | Injection, eptinezumab-jjmr, 1 mg | |
| C9064 | Mitomycin pyelocalyceal instillation, 1 mg | |
| C9065 | Injection, romidepsin, non-lyophilized (e.g. liquid), 1mg | |
| C9066 | Injection, sacituzumab govitecan-hziy, 2.5 mg | |
| C9067 | Gallium ga-68, dotatoc, diagnostic, 0.01 mci | |
| C9122 | Mometasone furoate sinus implant, 10 micrograms (sinuva) | |
| C9141 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl (jivi), 1 i.u. | |
| C9462 | Injection, delafloxacin, 1 mg | |
| C9463 | Injection, aprepitant, 1 mg | |
| C9464 | Injection, rolapitant, 0.5 mg | |
| C9465 | Hyaluronan or derivative, durolane, for intra-articular injection, per dose | |
| C9466 | Injection, benralizumab, 1 mg | |
| C9467 | Injection, rituximab and hyaluronidase, 10 mg | |
| C9468 | Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, rebinyn, 1 i.u. | |
| C9469 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | |
| C9489 | Injection, nusinersen, 0.1 mg | |
| C9490 | Injection, bezlotoxumab, 10 mg | |
| C9491 | Injection, avelumab, 10 mg | |
| C9492 | Injection, durvalumab, 10 mg | |
| C9493 | Injection, edaravone, 1 mg | |
| C9494 | Injection, ocrelizumab, 1 mg | |
| C9745 | Nasal endoscopy, surgical; balloon dilation of eustachian tube | |
| C9746 | Transperineal implantation of permanent adjustable balloon continence device, with cystourethroscopy, when performed and/or fluoroscopy, when performed | |
| C9747 | Ablation of prostate, transrectal, high intensity focused ultrasound (hifu), including imaging guidance | |
| C9749 | Repair of nasal vestibular lateral wall stenosis with implant(s) | |
| C9750 | Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation and peri-operative interrogation and programming; complete system (includes device and electrode) | |
| C9761 | Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter) | |
| C9768 | Endoscopic ultrasound-guided direct measurement of hepatic portosystemic pressure gradient by any method (list separately in addition to code for primary procedure) | |
| C9769 | Cystourethroscopy, with insertion of temporary prostatic implant/stent with fixation/anchor and incisional struts | |
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | |
| Q1001 | NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 1 AS DEFINED IN FEDERAL REGISTER NOTICE, VOL 65, DATED MAY 3, 2000 | |
| Q1002 | NEW TECHNOLOGY INTRAOCULAR LENS CATEGORY 2 AS DEFINED IN FEDERAL REGISTER NOTICE, VOL 65, DATED MAY 3, 2000 | |
| Q1003 | New technology intraocular lens category 3 (reduced spherical aberration) | |
| Q1004 | New technology intraocular lens category 4 as defined in federal register notice | |
| Q1005 | New technology intraocular lens category 5 as defined in federal register notice | |
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