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64569 | Revise/repl vagus n eltrd | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1778 | VNS THERAPY PERENNIAL FLEX | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1816 | USER KIT - NALU MEDICAL | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0295 | Electromagnetic therapy onc | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5275 | HC EARMOLD IMPRESSIONS EACH | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61850 | PR TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61870 | Implant neuroelectrodes | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61885 | PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61886 | PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5267 | Hearing aid sup/access/dev | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8687 | KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1767 | VERCISE GENUS R16 IPG KIT | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
A4595 | TENS suppl 2 lead per month | HCPCS | The authors concluded that the combined use of sulodexide and melatonin confirmed to an important and promising therapeutically option in the tinnitus management. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61867 | PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0329 | PR ELECTROMAGNTIC TX FOR ULCERS | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8614 | SYS IMPLANT COCHLEAR BONEBRIDGE | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95970 | PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1883 | XTN NRSTM PERC 2.16MM | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device, replacement | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8682 | Implt neurostim radiofq rec | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
99183 | PR PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61868 | PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95975 | Cranial neurostim complex | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95979 | Analyz neurostim brain addon | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8685 | Implt nrostm pls gen sng rec | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92590 | HC HEARING AID EXAMINATION AND SELECTION; MONAURAL | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61888 | Revise/remove neuroreceiver | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
69930 | PR COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8689 | SYSTEM CHARGING AXONICS WRELS | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5298 | Hearing aid noc | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
90867 | PR REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
90868 | PR THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8681 | REMOTE SLEEP | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61860 | PR CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
J2001 | Xylocaine 2% SYRINGE 100mg (Lidocaine) | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8688 | Implt nrostm pls gen dua non | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5010 | HC ASSESSMENT HEARING AID | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
E0730 | Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0277 | PR HBOT, FULL BODY CHAMBER, 30M | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
64550 | SBT PTA TENS APPLICATION UNATTENDED | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8695 | External recharg sys extern | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61864 | PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8683 | TRANSMITTER SGL | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92601 | PR ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8686 | Implt nrostm pls gen sng non | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61880 | Revise/remove neuroelectrode | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
92604 | Reprogram cochlear implt 7/> | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
64568 | PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61863 | PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
95974 | Cranial neurostim complex | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
64569 | Revise/repl vagus n eltrd | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1778 | VNS THERAPY PERENNIAL FLEX | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1816 | USER KIT - NALU MEDICAL | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
G0295 | Electromagnetic therapy onc | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5275 | HC EARMOLD IMPRESSIONS EACH | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61850 | PR TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61870 | Implant neuroelectrodes | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61885 | PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
61886 | PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
V5267 | Hearing aid sup/access/dev | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
L8687 | KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
C1767 | VERCISE GENUS R16 IPG KIT | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
A4595 | TENS suppl 2 lead per month | HCPCS | |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|64550||Application of surface (transcutaneous) neurostimulator|
|CPT codes not covered for indications listed in the CPB:|
|61850||Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical|
|61860||Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical|
|61863||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), without use of intraoperative microelectrode recording; first array|
|+61864||each additional array (List separately in addition to primary procedure)|
|61867||Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implantation of neurostumulator electrode array in subcortical site(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular, periaqueductal gray), with use of intraoperative microelectrode recording; first array|
|+61868||each additional array (List separately in addition to primary procedure)|
|61870||Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical|
|61880||Revision or removal of intracranial neurostimulator electrodes|
|61885||Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array|
|61886||with connection to 2 or more electrode arrays|
|61888||Revision or removal of cranial neurostimulator pulse generator or receiver|
|64568||Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator|
|64569||Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator|
|69930||Cochlear device implantation, with or without mastoidectomy|
|90867||Therapeutic repetitive transcranial magnetic stimulation treatment; planning|
|90868||delivery and management, per session|
|92590||Hearing aid examination and selection; monaural|
|92601 - 92604||Diagnostic analysis of cochlear implant|
|95970||Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming|
|95974||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour|
|95975||Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)|
|+95979||each additional 30 minutes after first hour (List separately in addition to code for primary procedure|
|99183||Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session|
|HCPCS codes covered if selection criteria are met:|
|A4595||Electrical stimulator supplies, 2 lead, per month, (e.g. TENS, NMES)|
|E0720||Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation|
|E0730||Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation|
|HCPCS codes not covered for indications listed in the CPB:|
|C1767||Generator, neurostimulator (implantable), nonrechargeable|
|C1778||Lead, neurostimulator (implantable)|
|C1816||Receiver and/or transmitter, neurostimulator (implantable)|
|C1883||Adaptor/ extension, pacing lead or neurostimulator lead (implantable)|
|G0277||Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval|
|G0295||Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses|
|J2001||Injection, lidocaine HCl for intravenous infusion, 10 mg -|
|L8614 - L8629||Cochlear implant components|
|L8681||Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only|
|L8682||Implantable neurostimulator radiofrequency receiver|
|L8683||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8685||Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver|
|L8686||Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension|
|L8687||Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension|
|L8688||Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension|
|L8689||External recharging system for battery (internal) for use with implanted neurostimulator, replacement only|
|L8695||External recharging system for battery (external) for use with implantable neurostimulator, replacement only|
|V5010 - V5267, V5275, V5298||Hearing aid services and supplies|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H93.11 - H93.19||Tinnitus|
Transcutaneous Electrical Nerve Stimulation for Tinnitus:
Tinnitus Instruments (Maskers, Hearing Aids):
Ear Canal Magnets and Electromagnetic Stimulation:
Tinnitus Retraining Therapy:
Transcranial Magnetic Stimulation:
Transmeatal Laser Irradiation:
Hyperbaric Oxygen Therapy:
Sequential Phase Shift Sound Cancellation Treatment:
Neuromonics Tinnitus Treatment:
Auditory Perceptual Training:
Intra-Tympanic Administration of Corticosteroids:
Deep Brain Stimulation:
Vagal Nerve Stimulation: |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.24 per approval by Medical Policy Advisory Committee (MPAC)
7/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/20/2005: Code Reference section updated, codes 38230, G0355-G0364 added, J9000-J9999 deleted; ICD9 procedure codes 41.02, 41.03, 41.04, 41.09 added
3/15/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. |
86825 | X-MATCHAHG | HCPCS | CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. |
86826 | Hla x-match noncytotoxc addl | HCPCS | CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/26/2008: Policy description updated, policy statements unchanged. "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. |
86826 | Hla x-match noncytotoxc addl | HCPCS | "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. |
G0267 | Bone marrow or psc harvest | CPT | "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. |
S2140 | Cord blood harvesting for transplantation, allogeneic | HCPCS | "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. |
G0265 | Cryopresevation Freeze+stora | CPT | "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. |
G0266 | Thawing + expansion froz cel | CPT | "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. |
86825 | X-MATCHAHG | HCPCS | "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. |
S2142 | Cord blood-derived stem-cell transplantation, allogeneic | HCPCS | "High-dose chemotherpay" term removed from title
1/6/2009: Policy reviewed, "prior authorization before evaluation" deleted
04/26/2010: Policy title revised to change “Stem-Cell Support” to “Stem-Cell Transplantation.” Policy description updated regarding conventional preparative conditioning and reduced-intensity conditioning for HSCT; however, the policy statement was unchanged. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. |
86826 | Hla x-match noncytotoxc addl | HCPCS | FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. |
G0267 | Bone marrow or psc harvest | CPT | FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. |
S2140 | Cord blood harvesting for transplantation, allogeneic | HCPCS | FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. |
G0265 | Cryopresevation Freeze+stora | CPT | FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. |
G0266 | Thawing + expansion froz cel | CPT | FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. |
86825 | X-MATCHAHG | HCPCS | FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. |
S2142 | Cord blood-derived stem-cell transplantation, allogeneic | HCPCS | FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. |
86826 | Hla x-match noncytotoxc addl | HCPCS | Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. 10/05/2011: Policy reviewed; no changes. |
G0267 | Bone marrow or psc harvest | CPT | Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. 10/05/2011: Policy reviewed; no changes. |
S2140 | Cord blood harvesting for transplantation, allogeneic | HCPCS | Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. 10/05/2011: Policy reviewed; no changes. |
G0265 | Cryopresevation Freeze+stora | CPT | Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. 10/05/2011: Policy reviewed; no changes. |
G0266 | Thawing + expansion froz cel | CPT | Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 10/21/2010: Policy reviewed; no changes. 10/05/2011: Policy reviewed; no changes. |
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