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G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | 08/27/2015: 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. 04/04/2016: Policy description updated regarding FDA regulations. Policy statement updated to make minor changes: 1) "allogeneic stem cell" changed to "allogeneic hematopoietic stem cell" and 2) "Pancreas cancer" changed to "Pancreatic cancer." Investigative definitions updated in policy guidelines. 05/25/2016: Policy number added. |
38240 | Transplt allo hct/donor | HCPCS | 08/27/2015: 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. 04/04/2016: Policy description updated regarding FDA regulations. Policy statement updated to make minor changes: 1) "allogeneic stem cell" changed to "allogeneic hematopoietic stem cell" and 2) "Pancreas cancer" changed to "Pancreatic cancer." Investigative definitions updated in policy guidelines. 05/25/2016: Policy number added. |
38242 | Transplt allo lymphocytes | HCPCS | 08/27/2015: 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. 04/04/2016: Policy description updated regarding FDA regulations. Policy statement updated to make minor changes: 1) "allogeneic stem cell" changed to "allogeneic hematopoietic stem cell" and 2) "Pancreas cancer" changed to "Pancreatic cancer." Investigative definitions updated in policy guidelines. 05/25/2016: Policy number added. |
96445 | Chemotherapy, intracavitary | HCPCS | 08/27/2015: 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. 04/04/2016: Policy description updated regarding FDA regulations. Policy statement updated to make minor changes: 1) "allogeneic stem cell" changed to "allogeneic hematopoietic stem cell" and 2) "Pancreas cancer" changed to "Pancreatic cancer." Investigative definitions updated in policy guidelines. 05/25/2016: Policy number added. |
96446 | PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH | HCPCS | 08/27/2015: 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. 04/04/2016: Policy description updated regarding FDA regulations. Policy statement updated to make minor changes: 1) "allogeneic stem cell" changed to "allogeneic hematopoietic stem cell" and 2) "Pancreas cancer" changed to "Pancreatic cancer." Investigative definitions updated in policy guidelines. 05/25/2016: Policy number added. |
E0218 | Fluid circ cold pad w pump | 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. POLICY HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, HCPCS E0218 added
5/2/2002: Type of Service and Place of Service deleted
8/16/2005: Policy title "Polar Care" renamed "Cooling Devices," Description and Policy sections revised to be consistent with BCBSA policy # 1.01.26, Code Reference section updated, HCPCS E0236 added
4/25/2008: Policy reviewed, no changes
12/10/2009: Policy Exclusions revised to include FEP verbiage, HCPCS code E1399 added to Non-Covered Codes Table. 05/17/2011: Policy reviewed; no changes to policy statement. Removed outdated references from the Sources section. |
E0236 | Pump for water circulating pad | 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. POLICY HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, HCPCS E0218 added
5/2/2002: Type of Service and Place of Service deleted
8/16/2005: Policy title "Polar Care" renamed "Cooling Devices," Description and Policy sections revised to be consistent with BCBSA policy # 1.01.26, Code Reference section updated, HCPCS E0236 added
4/25/2008: Policy reviewed, no changes
12/10/2009: Policy Exclusions revised to include FEP verbiage, HCPCS code E1399 added to Non-Covered Codes Table. 05/17/2011: Policy reviewed; no changes to policy statement. Removed outdated references from the Sources section. |
E0218 | Fluid circ cold pad w pump | 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 HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, HCPCS E0218 added
5/2/2002: Type of Service and Place of Service deleted
8/16/2005: Policy title "Polar Care" renamed "Cooling Devices," Description and Policy sections revised to be consistent with BCBSA policy # 1.01.26, Code Reference section updated, HCPCS E0236 added
4/25/2008: Policy reviewed, no changes
12/10/2009: Policy Exclusions revised to include FEP verbiage, HCPCS code E1399 added to Non-Covered Codes Table. 05/17/2011: Policy reviewed; no changes to policy statement. Removed outdated references from the Sources section. 03/02/2012: Policy reviewed. |
E0236 | Pump for water circulating pad | 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 HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, HCPCS E0218 added
5/2/2002: Type of Service and Place of Service deleted
8/16/2005: Policy title "Polar Care" renamed "Cooling Devices," Description and Policy sections revised to be consistent with BCBSA policy # 1.01.26, Code Reference section updated, HCPCS E0236 added
4/25/2008: Policy reviewed, no changes
12/10/2009: Policy Exclusions revised to include FEP verbiage, HCPCS code E1399 added to Non-Covered Codes Table. 05/17/2011: Policy reviewed; no changes to policy statement. Removed outdated references from the Sources section. 03/02/2012: Policy reviewed. |
1999 | ANESTHESIOLOGY GROUP | CPT | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. |
43644 | PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
1999 | ANESTHESIOLOGY GROUP | CPT | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
S2082 | Lap adjustable gastric band | CPT | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
43633 | Removal of stomach partial | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
43847 | PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
43645 | PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
S2085 | Laparoscop gastric bypass | CPT | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
43848 | Revision gastroplasty | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. |
43644 | PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
S2082 | Lap adjustable gastric band | CPT | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
43633 | Removal of stomach partial | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
43847 | PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
43645 | PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
S2085 | Laparoscop gastric bypass | CPT | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
43848 | Revision gastroplasty | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." |
43644 | PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
S2082 | Lap adjustable gastric band | CPT | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
43633 | Removal of stomach partial | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
43847 | PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
43645 | PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
S2085 | Laparoscop gastric bypass | CPT | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
43848 | Revision gastroplasty | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. |
43644 | PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
S2082 | Lap adjustable gastric band | CPT | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
43847 | PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
43645 | PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
S2085 | Laparoscop gastric bypass | CPT | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
3/20/2006: Policy reviewed, no changes
6/13/2006: Policy updated. Singing River ( a self-funded group) will cover Gastric Banding/Lap Band procedure effective 9/1/2004
8/28/2006: Policy updated. |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopancreatic bypass (the Scopinaro procedure) with duodenal switch may be medically necessary, biliopancreatic bypass without duodenal switch, bariatric surgery as a cure for type 2 diabetes mellitus and endoscopic procedures are considered investigational. Policy exception section updated to include gastric sleeve coverage effective 5-1-2010 for Singing River and Mid Delta Home Health coverage language deleted. FEP Service Benefit plan language deleted. FEP prior authorization requirement and FDA language added to policy exception section. |
43774 | PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopancreatic bypass (the Scopinaro procedure) with duodenal switch may be medically necessary, biliopancreatic bypass without duodenal switch, bariatric surgery as a cure for type 2 diabetes mellitus and endoscopic procedures are considered investigational. Policy exception section updated to include gastric sleeve coverage effective 5-1-2010 for Singing River and Mid Delta Home Health coverage language deleted. FEP Service Benefit plan language deleted. FEP prior authorization requirement and FDA language added to policy exception section. |
43888 | PR GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopancreatic bypass (the Scopinaro procedure) with duodenal switch may be medically necessary, biliopancreatic bypass without duodenal switch, bariatric surgery as a cure for type 2 diabetes mellitus and endoscopic procedures are considered investigational. Policy exception section updated to include gastric sleeve coverage effective 5-1-2010 for Singing River and Mid Delta Home Health coverage language deleted. FEP Service Benefit plan language deleted. FEP prior authorization requirement and FDA language added to policy exception section. |
43770 | PR LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopancreatic bypass (the Scopinaro procedure) with duodenal switch may be medically necessary, biliopancreatic bypass without duodenal switch, bariatric surgery as a cure for type 2 diabetes mellitus and endoscopic procedures are considered investigational. Policy exception section updated to include gastric sleeve coverage effective 5-1-2010 for Singing River and Mid Delta Home Health coverage language deleted. FEP Service Benefit plan language deleted. FEP prior authorization requirement and FDA language added to policy exception section. |
43886 | Revise gastric port open | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopancreatic bypass (the Scopinaro procedure) with duodenal switch may be medically necessary, biliopancreatic bypass without duodenal switch, bariatric surgery as a cure for type 2 diabetes mellitus and endoscopic procedures are considered investigational. Policy exception section updated to include gastric sleeve coverage effective 5-1-2010 for Singing River and Mid Delta Home Health coverage language deleted. FEP Service Benefit plan language deleted. FEP prior authorization requirement and FDA language added to policy exception section. |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | FEP prior authorization requirement and FDA language added to policy exception section. Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. |
S9452 | Nutrition class | HCPCS | FEP prior authorization requirement and FDA language added to policy exception section. Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | FEP prior authorization requirement and FDA language added to policy exception section. Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | FEP prior authorization requirement and FDA language added to policy exception section. Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. |
S9452 | Nutrition class | HCPCS | Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. 08/19/2011: Policy statement revised to state that the patient must be at least 18 years of age instead of 21. |
S9452 | Nutrition class | HCPCS | Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. 08/19/2011: Policy statement revised to state that the patient must be at least 18 years of age instead of 21. |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. 08/19/2011: Policy statement revised to state that the patient must be at least 18 years of age instead of 21. |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. 08/19/2011: Policy statement revised to state that the patient must be at least 18 years of age instead of 21. |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. 08/19/2011: Policy statement revised to state that the patient must be at least 18 years of age instead of 21. Re-formatted the information in the policy statement regarding surgical procedures; intent unchanged. |
S9452 | Nutrition class | HCPCS | CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to the Covered Codes table. 08/19/2011: Policy statement revised to state that the patient must be at least 18 years of age instead of 21. Re-formatted the information in the policy statement regarding surgical procedures; intent unchanged. |
00100 | ANESTH SALIVARY GLAND | CPT | Note: Medical necessity is the overarching criteria for a service and the diagnosis code is used to indicate medical necessity in conjunction with a CPT code. On Oct. 1, 2014, ICD-10 will be implemented and will be the standard coding system for the U.S. ICD-10 is currently used by the rest of the world to report health care conditions. The most current list of codes in use is ICD-10 which is beginning to be implemented in the U.S. It will give billing and coding professionals and providers the ability to report conditions, diseases, and injuries with more accurate specificity, which will provide clearer information overall about a person’s health status and allow for better outcomes and care. CPT (Current Procedural Terminology) codes are published by the American Medical Association, and there are approximately 7,800 CPT codes ranging from 00100 through 99499, currently at use. |
00100 | ANESTH SALIVARY GLAND | CPT | The most current list of codes in use is ICD-10 which is beginning to be implemented in the U.S. It will give billing and coding professionals and providers the ability to report conditions, diseases, and injuries with more accurate specificity, which will provide clearer information overall about a person’s health status and allow for better outcomes and care. CPT (Current Procedural Terminology) codes are published by the American Medical Association, and there are approximately 7,800 CPT codes ranging from 00100 through 99499, currently at use. The U.S. and other countries use the fourth edition and they were designed to provide a uniform data set that could be used to describe medical, surgical, and diagnostic services rendered to patients. CPT codes are five-digit alphanumeric codes and consist of five numbers and occasionally may have four numbers and letter, depending on the type of service. |
00100 | ANESTH SALIVARY GLAND | CPT | CPT (Current Procedural Terminology) codes are published by the American Medical Association, and there are approximately 7,800 CPT codes ranging from 00100 through 99499, currently at use. The U.S. and other countries use the fourth edition and they were designed to provide a uniform data set that could be used to describe medical, surgical, and diagnostic services rendered to patients. CPT codes are five-digit alphanumeric codes and consist of five numbers and occasionally may have four numbers and letter, depending on the type of service. CPT codes are used to identify services provided to patients such as, medical, surgical, diagnostic, and radiological services. These codes are submitted with ICD-9 codes on claim forms to payers and that is what is used to determine reimbursement to a provider/facility. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | It is also used by physicians to report care they administer in inpatient facilities. Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. |
49540 | Repair lumbar hernia | HCPCS | It is also used by physicians to report care they administer in inpatient facilities. Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. |
99213 | Telehealth visit INT | HCPCS | It is also used by physicians to report care they administer in inpatient facilities. Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. |
71045 | XR CHEST 1 VIEW | HCPCS | It is also used by physicians to report care they administer in inpatient facilities. Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. |
27250 | TREAT HIP DISLOCATION | HCPCS | It is also used by physicians to report care they administer in inpatient facilities. Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. |
49540 | Repair lumbar hernia | HCPCS | Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. |
99213 | Telehealth visit INT | HCPCS | Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. |
71045 | XR CHEST 1 VIEW | HCPCS | Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. |
27250 | TREAT HIP DISLOCATION | HCPCS | Here’s a little behind the scenes about CPT ® codes being made. Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. |
49540 | Repair lumbar hernia | HCPCS | Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. |
99213 | Telehealth visit INT | HCPCS | Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. |
J3420 | Vitamin b12 inj per 1000 mcg | HCPCS | Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. |
71045 | XR CHEST 1 VIEW | HCPCS | Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. |
27250 | TREAT HIP DISLOCATION | HCPCS | Over 10,000 CPT codes are available and are updated at the start of each year and no memorization is needed. On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. |
49540 | Repair lumbar hernia | HCPCS | On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. |
99213 | Telehealth visit INT | HCPCS | On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. |
J3420 | Vitamin b12 inj per 1000 mcg | HCPCS | On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. |
71045 | XR CHEST 1 VIEW | HCPCS | On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. |
27250 | TREAT HIP DISLOCATION | HCPCS | On the insurance claim forms, CPT codes must be registered. Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. Using CDT ® codes, most dental and oral procedures are billed. |
49540 | Repair lumbar hernia | HCPCS | Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. Using CDT ® codes, most dental and oral procedures are billed. |
99213 | Telehealth visit INT | HCPCS | Examples of CPT codes:
99213 billed for an established office visit
27250 billed for treatment of hip dislocation
49540 billed for repair of a lumbar hernia
71045 billed for chest x-ray
90653 billed for flu injection
|HCPCS Level II (Health Care Procedural Coding System, Level II)||HCPCS Level II’s 7,000-plus alphanumeric codes, originally developed for use by Medicare , Medicaid, Blue Cross / Blue Shield, and other providers to report procedures and bill for supplies, are used for many more uses, such as quality measure monitoring, billing for outpatient surgery, and academic studies.|
Orthotic supplies, Vision supplies and other support. On the insurance claim forms, HCPCS codes have to be registered. Example of HCPCS for a drug injection: Patient receives an injection of B12 – J3420
|CDT® (Code on Dental Procedures and Nomenclature)|
The American Dental Association (ADA) owns and maintains CDT ® codes. The five-character codes start with the letter D which used to be the HCPCS Level II dental section. Using CDT ® codes, most dental and oral procedures are billed. |
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