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Geographic GPCI adjustments at the MAC level modify both rates from the national averages listed above

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In the CY 2017 OPPS/ASC final rule with comment period (81 FR 79796), we clarified that the reporting ratio does not apply to codes with status indicator Q4 because services and procedures coded with status indicator Q4 are either packaged or paid through the Clinical Laboratory Fee Schedule and are never paid separately through the OPPS

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The code can specify the side (M54.41 for right, M54.42 for left)