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L8688 | Implt nrostm pls gen dua non | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
A4633 | Uvl replacement bulb | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
36515 | Apheresis adsorp/reinfuse | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
G0277 | PR HBOT, FULL BODY CHAMBER, 30M | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
L8695 | External recharg sys extern | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1380 | Injection, estradiol valerate, up to 10 mg | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1572 | IVIG FLEBOGAMMA 500 MGJW | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1000 | INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J9217 | LUPRON DEPOT IM 1 MONTH PWD FOR SUSP 7.5 | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
62180 | PR VENTRICULOCISTERNOSTOMY | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
38240 | Transplt allo hct/donor | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
61864 | PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
98960 | PR EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J0900 | TESTOSTERONE ENANTHATE, TO 1CC, INJ | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
L8683 | TRANSMITTER SGL | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
62160 | PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
95978 | Analyze neurostim brain/1h | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
A4575 | Hyperbaric o2 chamber disps | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
64553 | PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
E0446 | Topical ox deliver sys, nos | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
L8686 | Implt nrostm pls gen sng non | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
36516 | PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
S0190 | MIFEPRISTONE ORAL 200 MG | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
61880 | Revise/remove neuroelectrode | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
61863 | PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
95974 | Cranial neurostim complex | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1050 | MEDRXYPRGTRN 150MG INJ Injectable Drugs Not on Fee Schedule | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1569 | ORAL IMMUNE GLOBULIN (GAMMAGARD LIQUID) 10% | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1568 | OCTAGAM INJECTION | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
63746 | Removal of spinal shunt | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
C1778 | VNS THERAPY PERENNIAL FLEX | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
C1816 | USER KIT - NALU MEDICAL | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1561 | ORAL IMMUNE GLOBULIN (GAMUNEX-C) 10% | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1953 | levetriracetam per 10 mg | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1459 | PRIVIGEN 1 G/10 ML IV SOLN (WRAPPED) | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
61885 | PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1071 | TESTOSTRONE CYP 1MG 200MG 1ML SNIJ | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
S2107 | Adoptive immunotherapy | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
38242 | Transplt allo lymphocytes | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
L8687 | KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1438 | Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J1566 | IVIG POWDER NOS 10 G | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
C1767 | VERCISE GENUS R16 IPG KIT | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
J9219 | Leuprolide acetate implant, 65 mg | HCPCS | Nevertheless, results from ongoing phase III trials are needed to verify whether this drug has a significant clinical effect on cognition in association with AChEIs. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|36514||Therapeutic apheresis; for plasma pheresis|
|36515||with extracorporeal immunoadsorption and plasma reinfusion|
|36516||with extracorporeal selective adsorption or selective filtration and plasma reinfusion|
|38240||Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor|
|38242||Allogeneic lymphocyte infusions|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+ 61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostimulator electrode array in subcortical site (e.g., thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+ 61868||each additional array (List separately in addition to primary procedure)|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|+ 62160||Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)|
|62180 - 62258||Cerebrospinal fluid (CSF shunt)|
|63740 - 63746||Shunt, spinal CSF|
|64553||Percutaneous implantation of neurostimulator electrodes; cranial nerve|
|90281 - 90283||Immune globulin (Ig), human|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|95974||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|+ 95975||complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|95978||Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent programming; first hour|
|+ 95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|98960||Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient [Applied Behavioral Analysis]|
|HCPCS codes not covered for indications listed in the CPB:|
|A4575||Topical hyperbaric oxygen chamber, disposable|
|A4633||Replacement bulb/lamp for ultraviolet light therapy system, each|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|E0203||Therpeutic lightbox, minimum 10,000 lux table top model|
|E0446||Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|J0900||Injection, testosterone enanthate and estradiol valerate, up to 1cc|
|J1000||Injection, depo-estradiol cypionate, up to 5 mg|
|J1050||Injection, medroxyprogesterone acetate, 1 mg|
|J1060||Injection, testosterone cypionate and estradiol cypionate, up to 1 ml|
|J1071||Injection, testosterone cypionate, 1 mg|
|J1380||Injection, estradiol valerate, up to 10 mg|
|J1410||Injection, estrogen conjugated, per 25 mg|
|J1438||Injection, etanercept, 25 mg|
|J1459||Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1561||Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1568||Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1569||Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg|
|J1572||Injection, immune globulin, (Flebogamma / Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg|
|J1950||Injection, leuprolide acetate (for depot suspension), per 3.75 mg|
|J1953||Injection, levetiracetam, 10 mg|
|J3121||Injection, testosterone enanthate, 1mg|
|J3145||Injection, testosterone undecanoate, 1 mg|
|J9217||Leuprolide acetate (for depot suspension), 7.5 mg|
|J9218||Leuprolide acetate implant, 65 mg|
|J9219||Leuprolide acetate, per 1 mg|
|L8680||Implantable neurostimulator electrode, each|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Implantable neurostimulator pulse generator, single array, rechargeable, includes extension|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implantable neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|S0190||Mitepristone, oral, 200 mg|
|S2107||Adoptive immunotherapy i.e., development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment|
|ICD-10 codes not covered for indications listed in the CPB:|
|G30.0 - G30.9||Alzheimer's disease| |
L7190 | Electronic elbow, adolescent, variety village or equal, myoelectronically controlled | HCPCS | 07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. |
L7191 | Electronic elbow, child, variety village or equal, myoelectronically controlled | HCPCS | 07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. |
L6880 | Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) | HCPCS | 07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. |
L7190 | Electronic elbow, adolescent, variety village or equal, myoelectronically controlled | HCPCS | 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. |
L7191 | Electronic elbow, child, variety village or equal, myoelectronically controlled | HCPCS | 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. |
L6880 | Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) | HCPCS | 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. |
L6026 | Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr | HCPCS | Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. |
L7190 | Electronic elbow, adolescent, variety village or equal, myoelectronically controlled | HCPCS | Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. |
L7191 | Electronic elbow, child, variety village or equal, myoelectronically controlled | HCPCS | Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. |
L6880 | Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) | HCPCS | Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. |
L6026 | Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr | HCPCS | 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. 10/20/2015: Policy description updated regarding devices. |
L6026 | Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr | HCPCS | Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. 10/20/2015: Policy description updated regarding devices. Policy statements unchanged. |
L6026 | Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr | HCPCS | 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. 10/20/2015: Policy description updated regarding devices. Policy statements unchanged. Policy guidelines updated to add medically necessary and investigative definitions. |
96115 | Neurobehavior status exam | HCPCS | References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
96117 | NEUROPSYCH TEST BATTERY | CPT | References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
96115 | Neurobehavior status exam | HCPCS | References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing| |
96117 | NEUROPSYCH TEST BATTERY | CPT | References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing| |
2015 | ENDOBUTTON 4X12MM STRL | CDM | Asthma emergency department visits include those with ICD-9-CM codes 493.0-493.49 and/or ICD-10-CM code J45
NumeratorNumber of emergency department visits where asthma is the primary (first-listed) diagnosis. DenominatorEstimated number of New Mexico residents in a specified population over a specified time period. Healthy People Objective: RD-2, Reduce hospitalizations for asthmaU.S. Target: Not applicable, see subobjectives in this category
Other ObjectivesCDC Environmental Public Health Tracking, Nationally Consistent Data and Measures (EPHT NCDM)
How Are We Doing?For the period 2010 to 2014, asthma ED visits generally increased and show modest declines in the last two years, 2015-2016. What Is Being Done?The New Mexico Department of Health Asthma Program collects, analyzes, and disseminates asthma data in order to identify populations that have high burden of asthma. |
1537 | New Technology - Level 37 | APC | CPC Exam Prep Quiz: Covers anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Covers: anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Number of flashcards: 172
- Link: https://quizlet.com/419356522/cpc-exam-prep-flash-cards/
This is a great all-around quiz that tests a little bit of everything across the CPC, from ocular surgery to respiratory anatomy to HIPAA compliance and ABNs (Advance Beneficiary Notifications). We recommend using this flashcard set to give yourself a good review of all the material you might see on the CPC. 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. |
5372 | Level 2 Urology and Relat | APC | CPC Exam Prep Quiz: Covers anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Covers: anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Number of flashcards: 172
- Link: https://quizlet.com/419356522/cpc-exam-prep-flash-cards/
This is a great all-around quiz that tests a little bit of everything across the CPC, from ocular surgery to respiratory anatomy to HIPAA compliance and ABNs (Advance Beneficiary Notifications). We recommend using this flashcard set to give yourself a good review of all the material you might see on the CPC. 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. |
33465 | Replace tricuspid valve | HCPCS | CPC Exam Prep Quiz: Covers anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Covers: anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Number of flashcards: 172
- Link: https://quizlet.com/419356522/cpc-exam-prep-flash-cards/
This is a great all-around quiz that tests a little bit of everything across the CPC, from ocular surgery to respiratory anatomy to HIPAA compliance and ABNs (Advance Beneficiary Notifications). We recommend using this flashcard set to give yourself a good review of all the material you might see on the CPC. 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. |
9356 | Inj golodirsen 10 mg | APC | CPC Exam Prep Quiz: Covers anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Covers: anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Number of flashcards: 172
- Link: https://quizlet.com/419356522/cpc-exam-prep-flash-cards/
This is a great all-around quiz that tests a little bit of everything across the CPC, from ocular surgery to respiratory anatomy to HIPAA compliance and ABNs (Advance Beneficiary Notifications). We recommend using this flashcard set to give yourself a good review of all the material you might see on the CPC. 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. |
93565 | PR NJX DRG C-CATHJ SLCTV L VNTRC/R ATRIAL ANGRPHS&I | HCPCS | CPC Exam Prep Quiz: Covers anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Covers: anatomy & physiology, medical terminology, eye & ocular surgery coding, practice management, and more
- Number of flashcards: 172
- Link: https://quizlet.com/419356522/cpc-exam-prep-flash-cards/
This is a great all-around quiz that tests a little bit of everything across the CPC, from ocular surgery to respiratory anatomy to HIPAA compliance and ABNs (Advance Beneficiary Notifications). We recommend using this flashcard set to give yourself a good review of all the material you might see on the CPC. 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. |
33465 | Replace tricuspid valve | HCPCS | We recommend using this flashcard set to give yourself a good review of all the material you might see on the CPC. 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. |
1537 | New Technology - Level 37 | APC | We recommend using this flashcard set to give yourself a good review of all the material you might see on the CPC. 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. |
5372 | Level 2 Urology and Relat | APC | We recommend using this flashcard set to give yourself a good review of all the material you might see on the CPC. 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. |
33465 | Replace tricuspid valve | HCPCS | 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. For bonus points, do the coding cards back-to-front and really get your brain moving. |
1537 | New Technology - Level 37 | APC | 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. For bonus points, do the coding cards back-to-front and really get your brain moving. |
5372 | Level 2 Urology and Relat | APC | 2. AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. For bonus points, do the coding cards back-to-front and really get your brain moving. |
33465 | Replace tricuspid valve | HCPCS | AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. For bonus points, do the coding cards back-to-front and really get your brain moving. 4. |
1537 | New Technology - Level 37 | APC | AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. For bonus points, do the coding cards back-to-front and really get your brain moving. 4. |
5372 | Level 2 Urology and Relat | APC | AAPC CPC Practice Cards: excellent formatting, with explanations
- Covers: Anatomy and physiology, healthcare regulations, CPT, ICD-10
- Number of flashcards: 10
- Link: https://quizlet.com/533465552/aapc-cpc-practice-exam-f-flash-cards/
3. CPC Practice Exam Quizlet - 150 Questions: medical terminology and lots and lots of coding guidelines
- Covers: Medical terminology, CPT, ICD-10, HCPCS Level II, anatomy and physiology, surgical coding
- Number of flashcards: 150
- Link: https://quizlet.com/211537288/cpc-practice-exam-150-questions-flash-cards/
This one is great because it's heavy on the coding. There are 50+ questions just diagnosing codes based on evidence. For bonus points, do the coding cards back-to-front and really get your brain moving. 4. |
9408 | Inj. naxitamab-gqgk, 1 mg | APC | Use it to dive deep into all the healthcare industry terminology and 3-letter acronyms you're going to use to do your job every day, or as a refresher once you've already got the gist. After this set, you'll look and sound like a professional coder. 5. AAPC CPC Practice Questions Quizlet: ALL the case studies practice you could want. - Covers: CPT, ICD-10, HCPCS Level II, Anatomy and physiology, Evaluation and management, Healthcare Terminology, Coding Guidelines, and more
- Number of flashcards: 234
- Link: https://quizlet.com/394087957/aapc-cpc-practice-questions-flash-
We saved the best for last. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | The Healthcare Common Procedure Coding System (HCPCS) is a two-tiered system that includes Common Procedure Terminology, at Level I, which is usually referred to as CPT codes. More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. For this reason, both medical billers and medical coders need a solid understanding of how these codes are meant to be used, the kind of understanding that can only be gained through a formal education program of study. |
0100 | Med-Surg | RC | Given that lipedema is thought to affect 11% of the adult female population (7), it is vital that more research funding be allocated and larger scale studies take place. "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828
Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. |
0200 | INTENSIVE CARE UNIT - GENERAL CLASSIFICATION | RC | Given that lipedema is thought to affect 11% of the adult female population (7), it is vital that more research funding be allocated and larger scale studies take place. "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828
Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. |
0129 | ROOM & BOARD - SEMI-PRIVATE (TWO BEDS) - OTHER | RC | Given that lipedema is thought to affect 11% of the adult female population (7), it is vital that more research funding be allocated and larger scale studies take place. "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828
Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. |
1002 | HC ASAM LEVEL 3.7WM INPATIENT WITHDRAW MANAGEMENT | RC | Given that lipedema is thought to affect 11% of the adult female population (7), it is vital that more research funding be allocated and larger scale studies take place. "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828
Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. |
0100 | Med-Surg | RC | "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828
Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. |
0200 | INTENSIVE CARE UNIT - GENERAL CLASSIFICATION | RC | "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828
Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. |
0129 | ROOM & BOARD - SEMI-PRIVATE (TWO BEDS) - OTHER | RC | "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828
Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. |
1002 | HC ASAM LEVEL 3.7WM INPATIENT WITHDRAW MANAGEMENT | RC | "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828
Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. |
0100 | Med-Surg | RC | We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286
2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site
3) Todd, Marie, Lipoedema: presentation and management. |
0200 | INTENSIVE CARE UNIT - GENERAL CLASSIFICATION | RC | We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286
2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site
3) Todd, Marie, Lipoedema: presentation and management. |
0129 | ROOM & BOARD - SEMI-PRIVATE (TWO BEDS) - OTHER | RC | We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286
2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site
3) Todd, Marie, Lipoedema: presentation and management. |
1002 | HC ASAM LEVEL 3.7WM INPATIENT WITHDRAW MANAGEMENT | RC | We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286
2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site
3) Todd, Marie, Lipoedema: presentation and management. |
0100 | Med-Surg | RC | E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286
2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site
3) Todd, Marie, Lipoedema: presentation and management. Chronic Oedema, 2010; 10-16
4) Schmeller W, Meier-Vollrath I, Chapter 7 Lipedema, http://www.hanse-klinik.com/englisch/Lipoedema.pdf
5) Allen E V, Hines E A, Lipoedema of the legs. A syndrome characterized by fat legs and edema. |
0200 | INTENSIVE CARE UNIT - GENERAL CLASSIFICATION | RC | E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286
2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site
3) Todd, Marie, Lipoedema: presentation and management. Chronic Oedema, 2010; 10-16
4) Schmeller W, Meier-Vollrath I, Chapter 7 Lipedema, http://www.hanse-klinik.com/englisch/Lipoedema.pdf
5) Allen E V, Hines E A, Lipoedema of the legs. A syndrome characterized by fat legs and edema. |
0129 | ROOM & BOARD - SEMI-PRIVATE (TWO BEDS) - OTHER | RC | E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286
2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site
3) Todd, Marie, Lipoedema: presentation and management. Chronic Oedema, 2010; 10-16
4) Schmeller W, Meier-Vollrath I, Chapter 7 Lipedema, http://www.hanse-klinik.com/englisch/Lipoedema.pdf
5) Allen E V, Hines E A, Lipoedema of the legs. A syndrome characterized by fat legs and edema. |
1002 | HC ASAM LEVEL 3.7WM INPATIENT WITHDRAW MANAGEMENT | RC | E88.21 stage 1
E88.22 stage 2
E88.23 stage 3
Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use:
457.1 "lymphedema" if there is swelling component
Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0
E88.2 "Lipomatosis, not elsewhere classified"
Lipomatosis dolorosa of the legs
Painful column leg
Painful lipedema syndrome
Lipoedema (UK and Australian spelling)
Lipödem (German spelling)
There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books
eLearning from RCGP in the UK
Therapists and some physicians
http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18
http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95
For Physical Therapists
http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19
There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers
Back to top
1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286
2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site
3) Todd, Marie, Lipoedema: presentation and management. Chronic Oedema, 2010; 10-16
4) Schmeller W, Meier-Vollrath I, Chapter 7 Lipedema, http://www.hanse-klinik.com/englisch/Lipoedema.pdf
5) Allen E V, Hines E A, Lipoedema of the legs. A syndrome characterized by fat legs and edema. |
0194 | Subacute | RC | 2007;14(1):1–3. Peden A, Franklin RC, Mahony A, Barnsley P, Scarr J. Using a retrospective cross-sectional study to analyse unintentional fatal drowning in Australia: ICD-10 coding-based methodologies verses actual deaths. BMJ Open. 2017;7(e019407). |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | For this procedure, we’d code 35471 for “transluminal balloon angioplasty, percutaneous; renal or other visceral artery,” and we’d add the modifier -66 for “surgical team.” So we’d end up with 35471-66. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Physical Status Modifier (For Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
These are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
These are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
- 2014 Level I and Level II CPT Modifiers
- CPT and HCPCS Level II Modifiers
- 2012 Coding Modifiers Table
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
- 2014 Level I and Level II CPT Modifiers
- CPT and HCPCS Level II Modifiers
- 2012 Coding Modifiers Table
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. In this webinar, you will learn about the 143 deleted codes and why they were given the boot. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
- 2014 Level I and Level II CPT Modifiers
- CPT and HCPCS Level II Modifiers
- 2012 Coding Modifiers Table
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. In this webinar, you will learn about the 143 deleted codes and why they were given the boot. You will also learn the 264 New codes and when to use them and if they replaced older codes and more. |
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