Split (1)

train · 15.7k rows

code stringlengths 4 12	description stringlengths 2 264	codetype stringclasses 8 values	context stringlengths 160 15.5k
G0359	Chemotherapy IV one hr initi	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC) 7/14/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, no changes 10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted 3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged.
38230	PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC) 7/14/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, no changes 10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted 3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged.
G0361	Prolong chemo infuse>8hrs pu	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC) 7/14/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, no changes 10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted 3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged.
G0357	IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC) 7/14/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, no changes 10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted 3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged.
G0356	HORMONAL ANTINEOPLASTIC	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC) 7/14/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, no changes 10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted 3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged.
G0355	CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.23 per approval by Medical Policy Advisory Committee (MPAC) 7/14/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, no changes 10/26/2005: Code Reference section updated; CPT-4 code 38230 added; HCPCS code G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted 3/14/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 1/06/2009: Policy reviewed. No changes. 4/26/2010: Policy title updated to remove “High-Dose Chemotherapy” and to change “Stem-Cell Support” to “Stem-Cell Transplantation.” “High-dose chemotherapy” removed from policy statement; intent unchanged.
86826	Hla x-match noncytotoxc addl	HCPCS	Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table.
G0267	Bone marrow or psc harvest	CPT	Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table.
S2140	Cord blood harvesting for transplantation, allogeneic	HCPCS	Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table.
G0265	Cryopresevation Freeze+stora	CPT	Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table.
G0266	Thawing + expansion froz cel	CPT	Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table.
86825	X-MATCHAHG	HCPCS	Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table.
S2142	Cord blood-derived stem-cell transplantation, allogeneic	HCPCS	Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table.
86826	Hla x-match noncytotoxc addl	HCPCS	FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
G0267	Bone marrow or psc harvest	CPT	FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
S2140	Cord blood harvesting for transplantation, allogeneic	HCPCS	FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
G0265	Cryopresevation Freeze+stora	CPT	FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
G0266	Thawing + expansion froz cel	CPT	FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
86825	X-MATCHAHG	HCPCS	FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
S2142	Cord blood-derived stem-cell transplantation, allogeneic	HCPCS	FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
86826	Hla x-match noncytotoxc addl	HCPCS	Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
G0267	Bone marrow or psc harvest	CPT	Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
S2140	Cord blood harvesting for transplantation, allogeneic	HCPCS	Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
G0265	Cryopresevation Freeze+stora	CPT	Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
G0266	Thawing + expansion froz cel	CPT	Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
86825	X-MATCHAHG	HCPCS	Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
S2142	Cord blood-derived stem-cell transplantation, allogeneic	HCPCS	Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
38241	Transplt autol hct/donor	HCPCS	03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446.
G0363	IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS	HCPCS	03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446.
38240	Transplt allo hct/donor	HCPCS	03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446.
38242	Transplt allo lymphocytes	HCPCS	03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446.
96445	Chemotherapy, intracavitary	HCPCS	03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446.
96446	PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH	HCPCS	03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446.
38241	Transplt autol hct/donor	HCPCS	12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
G0363	IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS	HCPCS	12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
38240	Transplt allo hct/donor	HCPCS	12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
38242	Transplt allo lymphocytes	HCPCS	12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
96445	Chemotherapy, intracavitary	HCPCS	12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
96446	PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH	HCPCS	12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
38241	Transplt autol hct/donor	HCPCS	Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
G0363	IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS	HCPCS	Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
38240	Transplt allo hct/donor	HCPCS	Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
38242	Transplt allo lymphocytes	HCPCS	Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
96445	Chemotherapy, intracavitary	HCPCS	Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
96446	PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH	HCPCS	Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
J0881	INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)	HCPCS	Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment.
J0885	INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS	HCPCS	Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment.
96372	THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR	HCPCS	Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment.
J0881	INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)	HCPCS	- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement.
J0885	INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS	HCPCS	- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement.
96372	THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR	HCPCS	- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement.
J0881	INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)	HCPCS	Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement. The length of a numeric type data element does not include the optional sign.
J0885	INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS	HCPCS	Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement. The length of a numeric type data element does not include the optional sign.
96372	THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR	HCPCS	Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement. The length of a numeric type data element does not include the optional sign.
85025	TTH CBC W/AUTO DIFF-SP	HCPCS	- Three-digit number reported (such as 31.2) = 31.2 - Two-digit number reported (such as 4.5) = 04.5 - Two-digit whole number reported (such as 28) = 28.0 - Single decimal position reported (such as .9) = 00.9 - One-digit whole number reported (such as 7) = 07.0 - Test result reported as 2-digits and 2 decimal places (such as 26.25) = 26.2 Medical records from physician or nonphysician practitioner, must be made available upon request and includes patient counseling with: - Diagnosis and prognosis - Treatment options/plan - Patient's weight in kilograms - Erythropoietin analog units administered per kilogram of body weight - If usual doses exceeding, medical justification of erythropoietin analogs administration - ICD-10 diagnosis alone does not ensure coverage - Side effects and recovery When documenting lab tests, include the treating physician's oncology flow sheet and note verbiage "CBC" or "WBC": - CPT 85025 or the complete blood count (CBC) with automated hemoglobin (Hgb), hematocrit (Hct), red blood cell count (RBC), white blood count (WBC) and platelet count and automated differential WBC count - CPT 85027 without automated differential WBC count - Without valid order, medical necessity not supported Top errors seen when documentation requested: - E/M - missing supportive documentation (i.e., daily and progress notes, evaluation, clinical documentation, etc.) - E/M - documentation supports CPT/HCPCS down coding - Injection/Infusion - documentation does not support medical necessity, missing physician order/intent - Imaging or Lab test - documentation supports CPT/HCPCS code change - Bundled service billed for separate payment - National Coverage Determination (NCD) Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (110.21) - CMS Internet Only Manual (IOM) Publication 100-02, Medicare Benefit Policy, Chapter 15, Sections 50-50.6 and 60; Incident To, Covered Medical Services, Off-label Drugs - CMS IOM Publication 100-04, Medicare Claims Processing, Chapter 12, Section 30.5; Chemotherapy Administration - CMS IOM Publication 100-04, Medicare Claims Processing, Chapter 17, Sections 40 and 100.2.9; Drugs and Biologicals - American Society of Clinical Oncology (ASCO) - CMS Oncology Care Model (OCM) 2016-2021 Last Updated Wed, 16 Dec 2020 20:51:20 +0000 The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.
85027	HEMOGRAM	HCPCS	- Three-digit number reported (such as 31.2) = 31.2 - Two-digit number reported (such as 4.5) = 04.5 - Two-digit whole number reported (such as 28) = 28.0 - Single decimal position reported (such as .9) = 00.9 - One-digit whole number reported (such as 7) = 07.0 - Test result reported as 2-digits and 2 decimal places (such as 26.25) = 26.2 Medical records from physician or nonphysician practitioner, must be made available upon request and includes patient counseling with: - Diagnosis and prognosis - Treatment options/plan - Patient's weight in kilograms - Erythropoietin analog units administered per kilogram of body weight - If usual doses exceeding, medical justification of erythropoietin analogs administration - ICD-10 diagnosis alone does not ensure coverage - Side effects and recovery When documenting lab tests, include the treating physician's oncology flow sheet and note verbiage "CBC" or "WBC": - CPT 85025 or the complete blood count (CBC) with automated hemoglobin (Hgb), hematocrit (Hct), red blood cell count (RBC), white blood count (WBC) and platelet count and automated differential WBC count - CPT 85027 without automated differential WBC count - Without valid order, medical necessity not supported Top errors seen when documentation requested: - E/M - missing supportive documentation (i.e., daily and progress notes, evaluation, clinical documentation, etc.) - E/M - documentation supports CPT/HCPCS down coding - Injection/Infusion - documentation does not support medical necessity, missing physician order/intent - Imaging or Lab test - documentation supports CPT/HCPCS code change - Bundled service billed for separate payment - National Coverage Determination (NCD) Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (110.21) - CMS Internet Only Manual (IOM) Publication 100-02, Medicare Benefit Policy, Chapter 15, Sections 50-50.6 and 60; Incident To, Covered Medical Services, Off-label Drugs - CMS IOM Publication 100-04, Medicare Claims Processing, Chapter 12, Section 30.5; Chemotherapy Administration - CMS IOM Publication 100-04, Medicare Claims Processing, Chapter 17, Sections 40 and 100.2.9; Drugs and Biologicals - American Society of Clinical Oncology (ASCO) - CMS Oncology Care Model (OCM) 2016-2021 Last Updated Wed, 16 Dec 2020 20:51:20 +0000 The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.
0264	IV Therapy - IV Therapy/Supplies	RC	Lauren took her acetaminophen orally so the concept ID 4132161 (“Oral”) is used.\| \|LOT_NUMBER\|\|NULL\|\|An identifier assigned to a particular quantity or lot of Drug product from the manufacturer. This information is rarely captured.\| \|PROVIDER_ID\|\|NULL\|\|If the drug record has a prescribing Provider listed, the ID for that Provider goes in this field. In that case this contains the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|509\|\|A foreign key to the VISIT_OCCURRENCE table during which the Drug was prescribed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|A foreign key to the VISIT_DETAIL table during which the Drug was prescribed.\| \|DRUG_SOURCE_ VALUE\|\|69842087651\|\|This is the source code for the Drug as it appears in the source data. In Lauren’s case the NDC code is stored here.\| \|DRUG_SOURCE_ CONCEPT_ID\|\|750264\|\|This is the Concept that represents the drug source value. The Concept 750264 standing for the NDC code for “Acetaminophen 325 MG Oral Tablet”.\| \|ROUTE_SOURCE_ VALUE\|\|NULL\|\|The verbatim information about the route of administration as detailed in the source.\| The PROCEDURE_OCCURRENCE table contains records of activities or processes ordered or carried out by a healthcare Provider on the patient with a diagnostic or therapeutic purpose.
0264	IV Therapy - IV Therapy/Supplies	RC	In that case this contains the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|509\|\|A foreign key to the VISIT_OCCURRENCE table during which the Drug was prescribed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|A foreign key to the VISIT_DETAIL table during which the Drug was prescribed.\| \|DRUG_SOURCE_ VALUE\|\|69842087651\|\|This is the source code for the Drug as it appears in the source data. In Lauren’s case the NDC code is stored here.\| \|DRUG_SOURCE_ CONCEPT_ID\|\|750264\|\|This is the Concept that represents the drug source value. The Concept 750264 standing for the NDC code for “Acetaminophen 325 MG Oral Tablet”.\| \|ROUTE_SOURCE_ VALUE\|\|NULL\|\|The verbatim information about the route of administration as detailed in the source.\| The PROCEDURE_OCCURRENCE table contains records of activities or processes ordered or carried out by a healthcare Provider on the patient with a diagnostic or therapeutic purpose. Procedures are present in various data sources in different forms with varying levels of standardization. For example: - Medical Claims include procedure codes that are submitted as part of a claim for health services rendered, including procedures performed.
0443	Speech-language Pathology - Group	RC	does it come from an insurance claim, EHR order, etc. For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.\| \|MODIFIER_CONCEPT_ ID\|\|0\|\|This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.\| \|QUANTITY\|\|0\|\|The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.\| \|PROVIDER_ID\|\|NULL\|\|If the Procedure record has a Provider listed, the ID for that Provider goes in this field. This should be a foreign key to the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|740\|\|If known, this is the Visit (represented as VISIT_occurrence_id taken from the VISIT_OCCURRENCE table) during which the procedure was performed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|If known, this is the Visit detail (represented as VISIT_detail_id taken from the VISIT_DETAIL table) during which the procedure was performed.\| \|PROCEDURE_SOURCE_ VALUE\|\|304435002\|\|The code or information for the Procedure as it appears in the source data.\| \|PROCEDURE_SOURCE_ CONCEPT_ID\|\|4127451\|\|This is the Concept that represents the procedure source value.\| \|MODIFIER_SOURCE_ VALUE\|\|NULL\|\|The source code for the modifier as it appears in the source data.\| 4.4 Additional Information This chapter covers only a portion of the tables available in the CDM as examples of how data is represented.
4127	CATH SWN/GZ VIP 5FR 110CM	CDM	does it come from an insurance claim, EHR order, etc. For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.\| \|MODIFIER_CONCEPT_ ID\|\|0\|\|This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.\| \|QUANTITY\|\|0\|\|The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.\| \|PROVIDER_ID\|\|NULL\|\|If the Procedure record has a Provider listed, the ID for that Provider goes in this field. This should be a foreign key to the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|740\|\|If known, this is the Visit (represented as VISIT_occurrence_id taken from the VISIT_OCCURRENCE table) during which the procedure was performed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|If known, this is the Visit detail (represented as VISIT_detail_id taken from the VISIT_DETAIL table) during which the procedure was performed.\| \|PROCEDURE_SOURCE_ VALUE\|\|304435002\|\|The code or information for the Procedure as it appears in the source data.\| \|PROCEDURE_SOURCE_ CONCEPT_ID\|\|4127451\|\|This is the Concept that represents the procedure source value.\| \|MODIFIER_SOURCE_ VALUE\|\|NULL\|\|The source code for the modifier as it appears in the source data.\| 4.4 Additional Information This chapter covers only a portion of the tables available in the CDM as examples of how data is represented.
0275	PACEMAKER, SINGLE CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)	RC	does it come from an insurance claim, EHR order, etc. For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.\| \|MODIFIER_CONCEPT_ ID\|\|0\|\|This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.\| \|QUANTITY\|\|0\|\|The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.\| \|PROVIDER_ID\|\|NULL\|\|If the Procedure record has a Provider listed, the ID for that Provider goes in this field. This should be a foreign key to the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|740\|\|If known, this is the Visit (represented as VISIT_occurrence_id taken from the VISIT_OCCURRENCE table) during which the procedure was performed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|If known, this is the Visit detail (represented as VISIT_detail_id taken from the VISIT_DETAIL table) during which the procedure was performed.\| \|PROCEDURE_SOURCE_ VALUE\|\|304435002\|\|The code or information for the Procedure as it appears in the source data.\| \|PROCEDURE_SOURCE_ CONCEPT_ID\|\|4127451\|\|This is the Concept that represents the procedure source value.\| \|MODIFIER_SOURCE_ VALUE\|\|NULL\|\|The source code for the modifier as it appears in the source data.\| 4.4 Additional Information This chapter covers only a portion of the tables available in the CDM as examples of how data is represented.
0443	Speech-language Pathology - Group	RC	For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.\| \|MODIFIER_CONCEPT_ ID\|\|0\|\|This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.\| \|QUANTITY\|\|0\|\|The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.\| \|PROVIDER_ID\|\|NULL\|\|If the Procedure record has a Provider listed, the ID for that Provider goes in this field. This should be a foreign key to the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|740\|\|If known, this is the Visit (represented as VISIT_occurrence_id taken from the VISIT_OCCURRENCE table) during which the procedure was performed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|If known, this is the Visit detail (represented as VISIT_detail_id taken from the VISIT_DETAIL table) during which the procedure was performed.\| \|PROCEDURE_SOURCE_ VALUE\|\|304435002\|\|The code or information for the Procedure as it appears in the source data.\| \|PROCEDURE_SOURCE_ CONCEPT_ID\|\|4127451\|\|This is the Concept that represents the procedure source value.\| \|MODIFIER_SOURCE_ VALUE\|\|NULL\|\|The source code for the modifier as it appears in the source data.\| 4.4 Additional Information This chapter covers only a portion of the tables available in the CDM as examples of how data is represented. You are encouraged to visit the wiki site19 for more information.
4127	CATH SWN/GZ VIP 5FR 110CM	CDM	For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.\| \|MODIFIER_CONCEPT_ ID\|\|0\|\|This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.\| \|QUANTITY\|\|0\|\|The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.\| \|PROVIDER_ID\|\|NULL\|\|If the Procedure record has a Provider listed, the ID for that Provider goes in this field. This should be a foreign key to the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|740\|\|If known, this is the Visit (represented as VISIT_occurrence_id taken from the VISIT_OCCURRENCE table) during which the procedure was performed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|If known, this is the Visit detail (represented as VISIT_detail_id taken from the VISIT_DETAIL table) during which the procedure was performed.\| \|PROCEDURE_SOURCE_ VALUE\|\|304435002\|\|The code or information for the Procedure as it appears in the source data.\| \|PROCEDURE_SOURCE_ CONCEPT_ID\|\|4127451\|\|This is the Concept that represents the procedure source value.\| \|MODIFIER_SOURCE_ VALUE\|\|NULL\|\|The source code for the modifier as it appears in the source data.\| 4.4 Additional Information This chapter covers only a portion of the tables available in the CDM as examples of how data is represented. You are encouraged to visit the wiki site19 for more information.
0275	PACEMAKER, SINGLE CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)	RC	For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.\| \|MODIFIER_CONCEPT_ ID\|\|0\|\|This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.\| \|QUANTITY\|\|0\|\|The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.\| \|PROVIDER_ID\|\|NULL\|\|If the Procedure record has a Provider listed, the ID for that Provider goes in this field. This should be a foreign key to the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|740\|\|If known, this is the Visit (represented as VISIT_occurrence_id taken from the VISIT_OCCURRENCE table) during which the procedure was performed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|If known, this is the Visit detail (represented as VISIT_detail_id taken from the VISIT_DETAIL table) during which the procedure was performed.\| \|PROCEDURE_SOURCE_ VALUE\|\|304435002\|\|The code or information for the Procedure as it appears in the source data.\| \|PROCEDURE_SOURCE_ CONCEPT_ID\|\|4127451\|\|This is the Concept that represents the procedure source value.\| \|MODIFIER_SOURCE_ VALUE\|\|NULL\|\|The source code for the modifier as it appears in the source data.\| 4.4 Additional Information This chapter covers only a portion of the tables available in the CDM as examples of how data is represented. You are encouraged to visit the wiki site19 for more information.
0443	Speech-language Pathology - Group	RC	For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.\| \|QUANTITY\|\|0\|\|The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.\| \|PROVIDER_ID\|\|NULL\|\|If the Procedure record has a Provider listed, the ID for that Provider goes in this field. This should be a foreign key to the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|740\|\|If known, this is the Visit (represented as VISIT_occurrence_id taken from the VISIT_OCCURRENCE table) during which the procedure was performed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|If known, this is the Visit detail (represented as VISIT_detail_id taken from the VISIT_DETAIL table) during which the procedure was performed.\| \|PROCEDURE_SOURCE_ VALUE\|\|304435002\|\|The code or information for the Procedure as it appears in the source data.\| \|PROCEDURE_SOURCE_ CONCEPT_ID\|\|4127451\|\|This is the Concept that represents the procedure source value.\| \|MODIFIER_SOURCE_ VALUE\|\|NULL\|\|The source code for the modifier as it appears in the source data.\| 4.4 Additional Information This chapter covers only a portion of the tables available in the CDM as examples of how data is represented. You are encouraged to visit the wiki site19 for more information. The CDM is designed to support a wide range of observational research activities.
4127	CATH SWN/GZ VIP 5FR 110CM	CDM	For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.\| \|QUANTITY\|\|0\|\|The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.\| \|PROVIDER_ID\|\|NULL\|\|If the Procedure record has a Provider listed, the ID for that Provider goes in this field. This should be a foreign key to the PROVIDER_ID from the PROVIDER table.\| \|VISIT_OCCURRENCE_ ID\|\|740\|\|If known, this is the Visit (represented as VISIT_occurrence_id taken from the VISIT_OCCURRENCE table) during which the procedure was performed.\| \|VISIT_DETAIL_ID\|\|NULL\|\|If known, this is the Visit detail (represented as VISIT_detail_id taken from the VISIT_DETAIL table) during which the procedure was performed.\| \|PROCEDURE_SOURCE_ VALUE\|\|304435002\|\|The code or information for the Procedure as it appears in the source data.\| \|PROCEDURE_SOURCE_ CONCEPT_ID\|\|4127451\|\|This is the Concept that represents the procedure source value.\| \|MODIFIER_SOURCE_ VALUE\|\|NULL\|\|The source code for the modifier as it appears in the source data.\| 4.4 Additional Information This chapter covers only a portion of the tables available in the CDM as examples of how data is represented. You are encouraged to visit the wiki site19 for more information. The CDM is designed to support a wide range of observational research activities.
1996	Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration	HCPCS	CMS is considering phasing out HCPCS. There are 3 levels within HCPCS: HCPCS Level 1 Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index). HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCPCS Level 3 Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding.
1996	Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration	HCPCS	There are 3 levels within HCPCS: HCPCS Level 1 Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index). HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCPCS Level 3 Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003.
1996	Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration	HCPCS	HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCPCS Level 3 Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003. Current Procedural Terminology (CPT) is an outpatient medical coding codeset that is copy-written by the American Medical Association.
1996	Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration	HCPCS	HCPCS Level 3 Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003. Current Procedural Terminology (CPT) is an outpatient medical coding codeset that is copy-written by the American Medical Association. Despite CPT's widespread use, you have to pay high licensing fees to use the CPT codeset.
1590	New Technology - Level 39	APC	JO - Digestive and Liver Disease. JF - Digestive and Liver Disease. SN - 1590-8658. ER - ... ICD-10-PCS Code 0DVH7DZ - Restriction of Cecum with Intraluminal Device, Via Natural or Artificial Opening - Codify by AAPC ICD-10-PCS code 0DVH7DZ for Restriction of Cecum with Intraluminal Device, Via Natural or Artificial Opening is a medical classification as listed by CMS under Gastrointestinal System range. New Town - Apple Apartments - Hotel a Praga, Repubblica Ceca - Hostelworld Prenota New Town - Apple Apartments a Praga, Repubblica Ceca online.
1590	New Technology - Level 39	APC	JF - Digestive and Liver Disease. SN - 1590-8658. ER - ... ICD-10-PCS Code 0DVH7DZ - Restriction of Cecum with Intraluminal Device, Via Natural or Artificial Opening - Codify by AAPC ICD-10-PCS code 0DVH7DZ for Restriction of Cecum with Intraluminal Device, Via Natural or Artificial Opening is a medical classification as listed by CMS under Gastrointestinal System range. New Town - Apple Apartments - Hotel a Praga, Repubblica Ceca - Hostelworld Prenota New Town - Apple Apartments a Praga, Repubblica Ceca online. Scegli le camere migliori del New Town - Apple Apartments e prenota la tua vacanza a Praga in tutta sicurezza!
G0358	IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0360	Each additional hr 1-8 hrs	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0363	IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
J9000	INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0364	HC BONE MARROW ASPIRATE & BIOPSY	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0362	Each add sequential infusion	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
J9999	Not otherwise classified, antineoplastic drugs	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0359	Chemotherapy IV one hr initi	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
38230	PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0361	Prolong chemo infuse>8hrs pu	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0357	IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0356	HORMONAL ANTINEOPLASTIC	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0355	CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC	HCPCS	In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates.
G0358	IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0360	Each additional hr 1-8 hrs	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0363	IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
J9000	INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0364	HC BONE MARROW ASPIRATE & BIOPSY	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0362	Each add sequential infusion	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
J9999	Not otherwise classified, antineoplastic drugs	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0359	Chemotherapy IV one hr initi	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
38230	PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0361	Prolong chemo infuse>8hrs pu	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0357	IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0356	HORMONAL ANTINEOPLASTIC	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0355	CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC	HCPCS	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated.
G0358	IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG	HCPCS	3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated. Peripheral T-cell lymphoma added as investigational for either autologous or allogeneic stem-cell support.
G0360	Each additional hr 1-8 hrs	HCPCS	3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “High-dose chemotherapy with allogeneic stem-cell support is considered investigational to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” changed to “High-dose chemotherapy with allogeneic stem-cell support may be considered medically necessary to treat NHL that progresses or relapses relatively soon after a prior course of high-dose chemotherapy with autologous stem-cell support.” 7/14/2005: Code Reference section updated, CPT code 38230 added covered codes, HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added covered codes, HCPCS J9000-J9999 statement added to HCPCS and all separately listed codes deleted 10/20/2005: Code Reference section updated, ICD9 procedure codes 41.01, 41.02, 41.03, 41.09 added 3/16/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 5/17/2007: Policy reviewed, description updated. Added marginal zone lymphoma with indolent behavior or lymphoma or lymphoplasmacytoid lymphoma medically necessary for patients with NHL subtypes IWF classified as indolent 9/13/2007: Code reference section updated per the annual ICD-9 code updates. ICD-9 codes 200.00-200.28 and 200.80-200.88 added 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/11/2008: Policy description and statements updated. Peripheral T-cell lymphoma added as investigational for either autologous or allogeneic stem-cell support.

Subsets and Splits

No community queries yet

The top public SQL queries from the community will appear here once available.