<?xml version="1.0" encoding="UTF-8"?>
<HCPCS>
<HCPC>
C7569
</HCPC>
<LongDescription>
Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report
</LongDescription>
<ShortDescription>
Ptca w/ ivus or oct
</ShortDescription>
<PricingIndicators>
<PricingIndicator>
<PricingIndicatorName>
99
</PricingIndicatorName>
<PricingIndicatorCode>
Value not established
</PricingIndicatorCode>
</PricingIndicator>
</PricingIndicators>
<MPI>
9
</MPI>
<MultiplePricingIndicatorCode>
Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
</MultiplePricingIndicatorCode>
<CIMs/>
<MCMs>
</MCMs>
<Statute>
1833(t)
</Statute>
<LabCertifications/>
<XReferences/>
<Coverage>
D
</Coverage>
<CoverageDescription>
Special coverage instructions apply
</CoverageDescription>
<ASCPayGrp>
YY
</ASCPayGrp>
<ASCPayGrpEffDate>
20260101
</ASCPayGrpEffDate>
<MOGPayGrp/>
<MOGPaymentGroupCode/>
<MOGPayInd/>
<MOGPaymentPolicyIndicator/>
<MOGEffDate/>
<ProcNote/>
<BETOS>
P2F
</BETOS>
<BETOSDescription>
Major procedure, cardiovascular-Other
</BETOSDescription>
<TypeOfServices>
<TypeOfService>
<TOS>
2
</TOS>
<TypeOfServiceCode>
Surgery
</TypeOfServiceCode>
</TypeOfService>
</TypeOfServices>
<AnestBaseUnits>
0
</AnestBaseUnits>
<CodeAddDate>
20260101
</CodeAddDate>
<ActionEffDate>
20260101
</ActionEffDate>
<TermDate/>
<ActionCode>
N
</ActionCode>
<ActionCodeDescription>
No maintenance for this code
</ActionCodeDescription>
</HCPCS>