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train · 15.7k rows

code stringlengths 4 12	description stringlengths 2 264	codetype stringclasses 8 values	context stringlengths 160 15.5k
J7187	Injection, von willebrand factor complex (humate-p), per iu vwf:rco	HCPCS	HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements.
J7184	Wilate injection	HCPCS	HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements.
J7182	Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu	HCPCS	Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201.
J7200	Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu	HCPCS	Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201.
J7201	Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.	HCPCS	Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201.
J7195	Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified	HCPCS	Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195.
J7182	Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu	HCPCS	Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195.
J7200	Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu	HCPCS	Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195.
J7201	Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.	HCPCS	Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195.
J7195	Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified	HCPCS	12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10.
J7182	Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu	HCPCS	12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10.
J7200	Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu	HCPCS	12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10.
J7201	Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.	HCPCS	12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10.
J7195	Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified	HCPCS	Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59.
J7200	Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu	HCPCS	Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59.
J7201	Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.	HCPCS	Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59.
J7184	Wilate injection	HCPCS	Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184.
J7195	Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified	HCPCS	Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184.
J7184	Wilate injection	HCPCS	05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184. 03/01/2016: Policy description updated to add the brand name Nuwiq® for Factor VIII (recombinant) and brand names Rixibus® and Ixinity® for Factor IX (recombinant).
J7184	Wilate injection	HCPCS	08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184. 03/01/2016: Policy description updated to add the brand name Nuwiq® for Factor VIII (recombinant) and brand names Rixibus® and Ixinity® for Factor IX (recombinant). Policy statement unchanged.
J7184	Wilate injection	HCPCS	Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184. 03/01/2016: Policy description updated to add the brand name Nuwiq® for Factor VIII (recombinant) and brand names Rixibus® and Ixinity® for Factor IX (recombinant). Policy statement unchanged. Policy guidelines updated to add medically necessary definition.
9071	Capsaicin 8% patch	APC	- Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.
9201	Rabies ig ht&sol human im	APC	- Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.
9214	Bevacizumab injection	APC	- Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.
9065	Argatroban esrd dialysis	APC	- Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.
9071	Capsaicin 8% patch	APC	The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.
9201	Rabies ig ht&sol human im	APC	The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.
9214	Bevacizumab injection	APC	The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.
9065	Argatroban esrd dialysis	APC	The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.
9071	Capsaicin 8% patch	APC	Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike.
9201	Rabies ig ht&sol human im	APC	Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike.
9214	Bevacizumab injection	APC	Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike.
9065	Argatroban esrd dialysis	APC	Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike.
9071	Capsaicin 8% patch	APC	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
9065	Argatroban esrd dialysis	APC	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
90716	VARIVAX PVT	HCPCS	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
90658	Iiv3 vaccine splt 0.5 ml im	HCPCS	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
9214	Bevacizumab injection	APC	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
99214	Telehealth Visit EXT	HCPCS	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
9201	Rabies ig ht&sol human im	APC	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
12002	S/LCA SCLP/NK EXTR 2.7-7.5CM	HCPCS	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
99397	PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	HCPCS	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
99201	Office Visit New Min	HCPCS	Source: https://www.aapc.com/resources/medical-coding/cpt.aspx What Are Examples of CPT codes - 99201 a physical exam - 90658 flu vaccination - 90716 chicken pox vaccine (varicella) - 12002 laceration repair - 99214 may be used for an office visit - 99397 may be used for a preventive exam if you are over 65 To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below: - CPT 2016 Professional Edition - 2016 ICD-10-CM Codebook - ICD-10-CM 2016 Code Set - HCPCS 2016 Level II Professional Edition - CPT Changes 2016: An Insider’s View Related CPT Coding Posts: - How to Look Up CPT Codes for FREE — 7 Steps!
0100	Med-Surg	RC	Given that lipedema is thought to affect 11% of the adult female population (7), it is vital that more research funding be allocated and larger scale studies take place. "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828 Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J.
0200	INTENSIVE CARE UNIT - GENERAL CLASSIFICATION	RC	Given that lipedema is thought to affect 11% of the adult female population (7), it is vital that more research funding be allocated and larger scale studies take place. "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828 Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J.
0129	ROOM & BOARD - SEMI-PRIVATE (TWO BEDS) - OTHER	RC	Given that lipedema is thought to affect 11% of the adult female population (7), it is vital that more research funding be allocated and larger scale studies take place. "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828 Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J.
1002	HC ASAM LEVEL 3.7WM INPATIENT WITHDRAW MANAGEMENT	RC	Given that lipedema is thought to affect 11% of the adult female population (7), it is vital that more research funding be allocated and larger scale studies take place. "LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828 Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J.
0100	Med-Surg	RC	"LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828 Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient.
0200	INTENSIVE CARE UNIT - GENERAL CLASSIFICATION	RC	"LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828 Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient.
0129	ROOM & BOARD - SEMI-PRIVATE (TWO BEDS) - OTHER	RC	"LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828 Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient.
1002	HC ASAM LEVEL 3.7WM INPATIENT WITHDRAW MANAGEMENT	RC	"LF14" or "EJ44" http://apps.who.int/classifications/icd11/browse/l-m/en#!http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1172950828 Lipedema has a diagnostic code in "ICD-10 2017" but not "ICD-10 2016". We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient.
0100	Med-Surg	RC	We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286 2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site 3) Todd, Marie, Lipoedema: presentation and management.
0200	INTENSIVE CARE UNIT - GENERAL CLASSIFICATION	RC	We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286 2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site 3) Todd, Marie, Lipoedema: presentation and management.
0129	ROOM & BOARD - SEMI-PRIVATE (TWO BEDS) - OTHER	RC	We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286 2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site 3) Todd, Marie, Lipoedema: presentation and management.
1002	HC ASAM LEVEL 3.7WM INPATIENT WITHDRAW MANAGEMENT	RC	We do not know when the US will move to "ICD-10 2017". The Germans have it in their version of "ICD-10 2016", "ICD-10 GM" now. E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286 2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site 3) Todd, Marie, Lipoedema: presentation and management.
0100	Med-Surg	RC	E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286 2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site 3) Todd, Marie, Lipoedema: presentation and management. Chronic Oedema, 2010; 10-16 4) Schmeller W, Meier-Vollrath I, Chapter 7 Lipedema, http://www.hanse-klinik.com/englisch/Lipoedema.pdf 5) Allen E V, Hines E A, Lipoedema of the legs. A syndrome characterized by fat legs and edema.
0200	INTENSIVE CARE UNIT - GENERAL CLASSIFICATION	RC	E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286 2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site 3) Todd, Marie, Lipoedema: presentation and management. Chronic Oedema, 2010; 10-16 4) Schmeller W, Meier-Vollrath I, Chapter 7 Lipedema, http://www.hanse-klinik.com/englisch/Lipoedema.pdf 5) Allen E V, Hines E A, Lipoedema of the legs. A syndrome characterized by fat legs and edema.
0129	ROOM & BOARD - SEMI-PRIVATE (TWO BEDS) - OTHER	RC	E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286 2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site 3) Todd, Marie, Lipoedema: presentation and management. Chronic Oedema, 2010; 10-16 4) Schmeller W, Meier-Vollrath I, Chapter 7 Lipedema, http://www.hanse-klinik.com/englisch/Lipoedema.pdf 5) Allen E V, Hines E A, Lipoedema of the legs. A syndrome characterized by fat legs and edema.
1002	HC ASAM LEVEL 3.7WM INPATIENT WITHDRAW MANAGEMENT	RC	E88.21 stage 1 E88.22 stage 2 E88.23 stage 3 Historical Alternate ICD-10 and ICD-9 codes: There is no clear-cut code, but some physicians use: 457.1 "lymphedema" if there is swelling component Q82.0 "hereditary lymphedema" http://www.icd10data.com/ICD10CM/Codes/Q00-Q99/Q80-Q89/Q82-/Q82.0 E88.2 "Lipomatosis, not elsewhere classified" Lipomatosis dolorosa of the legs Painful column leg Painful lipedema syndrome Lipoedema (UK and Australian spelling) Lipödem (German spelling) There are >20 books that mention lipedema, see the list here http://fatdisorders.org/research/books eLearning from RCGP in the UK Therapists and some physicians http://www.chirocredit.com/courses/index.php?catid=131&pid=20 then scroll to Lymphology 101; $18 http://www.nursingcenter.com/lnc/CEArticle?an=00129334-201002000-00010&Journal_ID=54015&Issue_ID=965181 ; $24.95 For Physical Therapists http://ce.todayinpt.com/course/pt07/lipedema-often-confused-with-lymphedema/ ; $19 There are >160 papers on lipedema listed on our site here: http://fatdisorders.org/research/lipedema-lipoedema-research-papers Back to top 1) Chen, S. G., Hsu, S. D., Chen, T. M., Wang, H. J. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57(3):282-286 2) http://www.tillysmidt.nl/LIPEDEMA%20%20Englisch%20for%20Lipoedeem.htm, adapted from this site 3) Todd, Marie, Lipoedema: presentation and management. Chronic Oedema, 2010; 10-16 4) Schmeller W, Meier-Vollrath I, Chapter 7 Lipedema, http://www.hanse-klinik.com/englisch/Lipoedema.pdf 5) Allen E V, Hines E A, Lipoedema of the legs. A syndrome characterized by fat legs and edema.
99213	Telehealth visit INT	HCPCS	When the coder locations the code J02.9 on the medical assert, it tells the insurance coverage organization that the client was observed since they ended up complaining of a sore throat. • CPT, or method, codes, tell the insurance policy business what techniques had been performed on the individual on the day that they have been noticed. For Prospective chart review , the code 99213 is employed to symbolize a common place of work pay a visit to. When the coder consists of the code 99213 on the assert, it tells the insurance policies organization that the health-related supplier executed a mid-range place of work visit. • HCPCS, or offer codes, are utilized to signify all of the other miscellaneous solutions or supplies provided to a client on the working day they had been observed.
99213	Telehealth visit INT	HCPCS	• CPT, or method, codes, tell the insurance policy business what techniques had been performed on the individual on the day that they have been noticed. For Prospective chart review , the code 99213 is employed to symbolize a common place of work pay a visit to. When the coder consists of the code 99213 on the assert, it tells the insurance policies organization that the health-related supplier executed a mid-range place of work visit. • HCPCS, or offer codes, are utilized to signify all of the other miscellaneous solutions or supplies provided to a client on the working day they had been observed. These codes are not constantly incorporated on a assert form simply because they incorporate provides or other services that are not included in the CPT ebook, these kinds of as ambulance transportation or sturdy health care equipment.
99213	Telehealth visit INT	HCPCS	For Prospective chart review , the code 99213 is employed to symbolize a common place of work pay a visit to. When the coder consists of the code 99213 on the assert, it tells the insurance policies organization that the health-related supplier executed a mid-range place of work visit. • HCPCS, or offer codes, are utilized to signify all of the other miscellaneous solutions or supplies provided to a client on the working day they had been observed. These codes are not constantly incorporated on a assert form simply because they incorporate provides or other services that are not included in the CPT ebook, these kinds of as ambulance transportation or sturdy health care equipment. Health care companies only invoice for CPT and HCPCS codes since they signify real companies and supplies presented to the individual.
99213	Telehealth visit INT	HCPCS	When the coder consists of the code 99213 on the assert, it tells the insurance policies organization that the health-related supplier executed a mid-range place of work visit. • HCPCS, or offer codes, are utilized to signify all of the other miscellaneous solutions or supplies provided to a client on the working day they had been observed. These codes are not constantly incorporated on a assert form simply because they incorporate provides or other services that are not included in the CPT ebook, these kinds of as ambulance transportation or sturdy health care equipment. Health care companies only invoice for CPT and HCPCS codes since they signify real companies and supplies presented to the individual. Each and every code is given an personal demand, and is individually reimbursed by the insurance firm.
V2799	Misc vision item or service	HCPCS	PMID 19874111 - Vision, learning and dyslexia. A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997; Accessed November, 2014. \|CPT\|\|92065\|\|Orthoptic and/or pleoptic training, with continuing medical direction and evaluation\| \|ICD-9 Procedure\|\|95.35\|\|Orthoptic training\| \|ICD-9 Diagnosis\|\|315.00-315.09\|\|Developmental reading disorder coding range\| \|378.83\|\|Other disorders of binocular eye movements; converge insufficiency or palsy\| \|HCPCS\|\|V2799\|\|Vision service, miscellaneous\| \|ICD-10-CM (effective 10/1/15)\|\|H51.11 -H51.12\|\|Convergence insufficiency and excess code range\| \|F81.0\|\|Specific reading disorder\| \|ICD-10-CM (effective 10/1/15)\|\|Not applicable. ICD-10-PCS codes are only used for inpatient services.
92065	PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP	HCPCS	PMID 19874111 - Vision, learning and dyslexia. A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997; Accessed November, 2014. \|CPT\|\|92065\|\|Orthoptic and/or pleoptic training, with continuing medical direction and evaluation\| \|ICD-9 Procedure\|\|95.35\|\|Orthoptic training\| \|ICD-9 Diagnosis\|\|315.00-315.09\|\|Developmental reading disorder coding range\| \|378.83\|\|Other disorders of binocular eye movements; converge insufficiency or palsy\| \|HCPCS\|\|V2799\|\|Vision service, miscellaneous\| \|ICD-10-CM (effective 10/1/15)\|\|H51.11 -H51.12\|\|Convergence insufficiency and excess code range\| \|F81.0\|\|Specific reading disorder\| \|ICD-10-CM (effective 10/1/15)\|\|Not applicable. ICD-10-PCS codes are only used for inpatient services.
V2799	Misc vision item or service	HCPCS	A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997; Accessed November, 2014. \|CPT\|\|92065\|\|Orthoptic and/or pleoptic training, with continuing medical direction and evaluation\| \|ICD-9 Procedure\|\|95.35\|\|Orthoptic training\| \|ICD-9 Diagnosis\|\|315.00-315.09\|\|Developmental reading disorder coding range\| \|378.83\|\|Other disorders of binocular eye movements; converge insufficiency or palsy\| \|HCPCS\|\|V2799\|\|Vision service, miscellaneous\| \|ICD-10-CM (effective 10/1/15)\|\|H51.11 -H51.12\|\|Convergence insufficiency and excess code range\| \|F81.0\|\|Specific reading disorder\| \|ICD-10-CM (effective 10/1/15)\|\|Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.\| \|Type of Service\|\|Vision\| \|Place of Service\|\|Physician’s Office\| \|7/31/96\|\|Add to Vision section\|\|New policy\| \|7/12/02\|\|Replace policy\|\|Policy reviewed without literature search; new review date only\| \|12/17/03\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section\| \|03/15/05\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged\| \|03/7/06\|\|Replace policy\|\|Policy reviewed with literature search; no change in policy statement\| \|01/10/08\|\|Replace Policy\|\|Policy reviewed with literature search; reference 10 added; no change in policy statement.\| \|03/12/09\|\|Replace policy\|\|Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.\| \|01/13/11\|\|Replace policy\|\|Policy updated with literature review; references added and reordered, clinical input reviewed.
92065	PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP	HCPCS	A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997; Accessed November, 2014. \|CPT\|\|92065\|\|Orthoptic and/or pleoptic training, with continuing medical direction and evaluation\| \|ICD-9 Procedure\|\|95.35\|\|Orthoptic training\| \|ICD-9 Diagnosis\|\|315.00-315.09\|\|Developmental reading disorder coding range\| \|378.83\|\|Other disorders of binocular eye movements; converge insufficiency or palsy\| \|HCPCS\|\|V2799\|\|Vision service, miscellaneous\| \|ICD-10-CM (effective 10/1/15)\|\|H51.11 -H51.12\|\|Convergence insufficiency and excess code range\| \|F81.0\|\|Specific reading disorder\| \|ICD-10-CM (effective 10/1/15)\|\|Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.\| \|Type of Service\|\|Vision\| \|Place of Service\|\|Physician’s Office\| \|7/31/96\|\|Add to Vision section\|\|New policy\| \|7/12/02\|\|Replace policy\|\|Policy reviewed without literature search; new review date only\| \|12/17/03\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section\| \|03/15/05\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged\| \|03/7/06\|\|Replace policy\|\|Policy reviewed with literature search; no change in policy statement\| \|01/10/08\|\|Replace Policy\|\|Policy reviewed with literature search; reference 10 added; no change in policy statement.\| \|03/12/09\|\|Replace policy\|\|Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.\| \|01/13/11\|\|Replace policy\|\|Policy updated with literature review; references added and reordered, clinical input reviewed.
V2799	Misc vision item or service	HCPCS	1997; Accessed November, 2014. \|CPT\|\|92065\|\|Orthoptic and/or pleoptic training, with continuing medical direction and evaluation\| \|ICD-9 Procedure\|\|95.35\|\|Orthoptic training\| \|ICD-9 Diagnosis\|\|315.00-315.09\|\|Developmental reading disorder coding range\| \|378.83\|\|Other disorders of binocular eye movements; converge insufficiency or palsy\| \|HCPCS\|\|V2799\|\|Vision service, miscellaneous\| \|ICD-10-CM (effective 10/1/15)\|\|H51.11 -H51.12\|\|Convergence insufficiency and excess code range\| \|F81.0\|\|Specific reading disorder\| \|ICD-10-CM (effective 10/1/15)\|\|Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.\| \|Type of Service\|\|Vision\| \|Place of Service\|\|Physician’s Office\| \|7/31/96\|\|Add to Vision section\|\|New policy\| \|7/12/02\|\|Replace policy\|\|Policy reviewed without literature search; new review date only\| \|12/17/03\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section\| \|03/15/05\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged\| \|03/7/06\|\|Replace policy\|\|Policy reviewed with literature search; no change in policy statement\| \|01/10/08\|\|Replace Policy\|\|Policy reviewed with literature search; reference 10 added; no change in policy statement.\| \|03/12/09\|\|Replace policy\|\|Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.\| \|01/13/11\|\|Replace policy\|\|Policy updated with literature review; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary\| \|1/12/12\|\|Replace policy\|\|Policy updated with literature search through November 2011; references added and reordered; policy statements unchanged\| \|1/10/13\|\|Replace policy\|\|Policy updated with literature search through November 2012; policy statements unchanged\| \|1/09/14\|\|Replace policy\|\|Policy updated with literature search through December 4, 2013; references 12 and 18 added.
92065	PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP	HCPCS	1997; Accessed November, 2014. \|CPT\|\|92065\|\|Orthoptic and/or pleoptic training, with continuing medical direction and evaluation\| \|ICD-9 Procedure\|\|95.35\|\|Orthoptic training\| \|ICD-9 Diagnosis\|\|315.00-315.09\|\|Developmental reading disorder coding range\| \|378.83\|\|Other disorders of binocular eye movements; converge insufficiency or palsy\| \|HCPCS\|\|V2799\|\|Vision service, miscellaneous\| \|ICD-10-CM (effective 10/1/15)\|\|H51.11 -H51.12\|\|Convergence insufficiency and excess code range\| \|F81.0\|\|Specific reading disorder\| \|ICD-10-CM (effective 10/1/15)\|\|Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.\| \|Type of Service\|\|Vision\| \|Place of Service\|\|Physician’s Office\| \|7/31/96\|\|Add to Vision section\|\|New policy\| \|7/12/02\|\|Replace policy\|\|Policy reviewed without literature search; new review date only\| \|12/17/03\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section\| \|03/15/05\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged\| \|03/7/06\|\|Replace policy\|\|Policy reviewed with literature search; no change in policy statement\| \|01/10/08\|\|Replace Policy\|\|Policy reviewed with literature search; reference 10 added; no change in policy statement.\| \|03/12/09\|\|Replace policy\|\|Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.\| \|01/13/11\|\|Replace policy\|\|Policy updated with literature review; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary\| \|1/12/12\|\|Replace policy\|\|Policy updated with literature search through November 2011; references added and reordered; policy statements unchanged\| \|1/10/13\|\|Replace policy\|\|Policy updated with literature search through November 2012; policy statements unchanged\| \|1/09/14\|\|Replace policy\|\|Policy updated with literature search through December 4, 2013; references 12 and 18 added.
V2799	Misc vision item or service	HCPCS	\|CPT\|\|92065\|\|Orthoptic and/or pleoptic training, with continuing medical direction and evaluation\| \|ICD-9 Procedure\|\|95.35\|\|Orthoptic training\| \|ICD-9 Diagnosis\|\|315.00-315.09\|\|Developmental reading disorder coding range\| \|378.83\|\|Other disorders of binocular eye movements; converge insufficiency or palsy\| \|HCPCS\|\|V2799\|\|Vision service, miscellaneous\| \|ICD-10-CM (effective 10/1/15)\|\|H51.11 -H51.12\|\|Convergence insufficiency and excess code range\| \|F81.0\|\|Specific reading disorder\| \|ICD-10-CM (effective 10/1/15)\|\|Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.\| \|Type of Service\|\|Vision\| \|Place of Service\|\|Physician’s Office\| \|7/31/96\|\|Add to Vision section\|\|New policy\| \|7/12/02\|\|Replace policy\|\|Policy reviewed without literature search; new review date only\| \|12/17/03\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section\| \|03/15/05\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged\| \|03/7/06\|\|Replace policy\|\|Policy reviewed with literature search; no change in policy statement\| \|01/10/08\|\|Replace Policy\|\|Policy reviewed with literature search; reference 10 added; no change in policy statement.\| \|03/12/09\|\|Replace policy\|\|Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.\| \|01/13/11\|\|Replace policy\|\|Policy updated with literature review; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary\| \|1/12/12\|\|Replace policy\|\|Policy updated with literature search through November 2011; references added and reordered; policy statements unchanged\| \|1/10/13\|\|Replace policy\|\|Policy updated with literature search through November 2012; policy statements unchanged\| \|1/09/14\|\|Replace policy\|\|Policy updated with literature search through December 4, 2013; references 12 and 18 added. Policy statements unchanged.\| \|1/15/15\|\|Replace policy\|\|Policy updated with literature review through December 3, 2014; references 22 and 25 added.
92065	PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP	HCPCS	\|CPT\|\|92065\|\|Orthoptic and/or pleoptic training, with continuing medical direction and evaluation\| \|ICD-9 Procedure\|\|95.35\|\|Orthoptic training\| \|ICD-9 Diagnosis\|\|315.00-315.09\|\|Developmental reading disorder coding range\| \|378.83\|\|Other disorders of binocular eye movements; converge insufficiency or palsy\| \|HCPCS\|\|V2799\|\|Vision service, miscellaneous\| \|ICD-10-CM (effective 10/1/15)\|\|H51.11 -H51.12\|\|Convergence insufficiency and excess code range\| \|F81.0\|\|Specific reading disorder\| \|ICD-10-CM (effective 10/1/15)\|\|Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.\| \|Type of Service\|\|Vision\| \|Place of Service\|\|Physician’s Office\| \|7/31/96\|\|Add to Vision section\|\|New policy\| \|7/12/02\|\|Replace policy\|\|Policy reviewed without literature search; new review date only\| \|12/17/03\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section\| \|03/15/05\|\|Replace policy\|\|Policy reviewed with literature search; policy statement unchanged\| \|03/7/06\|\|Replace policy\|\|Policy reviewed with literature search; no change in policy statement\| \|01/10/08\|\|Replace Policy\|\|Policy reviewed with literature search; reference 10 added; no change in policy statement.\| \|03/12/09\|\|Replace policy\|\|Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.\| \|01/13/11\|\|Replace policy\|\|Policy updated with literature review; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary\| \|1/12/12\|\|Replace policy\|\|Policy updated with literature search through November 2011; references added and reordered; policy statements unchanged\| \|1/10/13\|\|Replace policy\|\|Policy updated with literature search through November 2012; policy statements unchanged\| \|1/09/14\|\|Replace policy\|\|Policy updated with literature search through December 4, 2013; references 12 and 18 added. Policy statements unchanged.\| \|1/15/15\|\|Replace policy\|\|Policy updated with literature review through December 3, 2014; references 22 and 25 added.
L0100	CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
97799	Unlisted physcl med/rehab px	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
97703	PROSTHETIC CHECKOUT	CPT	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
L0110	CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
S1040	Cranial remolding orthosis	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
L0100	CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
97799	Unlisted physcl med/rehab px	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
97703	PROSTHETIC CHECKOUT	CPT	The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
L0110	CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
S1040	Cranial remolding orthosis	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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
L0100	CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL	HCPCS	POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
97799	Unlisted physcl med/rehab px	HCPCS	POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
97703	PROSTHETIC CHECKOUT	CPT	POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
L0110	CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED	HCPCS	POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
S1040	Cranial remolding orthosis	HCPCS	POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
L0100	CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL	HCPCS	10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged.
S1040	Cranial remolding orthosis	HCPCS	10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged.
97799	Unlisted physcl med/rehab px	HCPCS	10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged.
L0110	CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED	HCPCS	10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged.
J0881	INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)	HCPCS	Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment.
J0885	INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS	HCPCS	Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment.
96372	THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR	HCPCS	Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment.
J0881	INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)	HCPCS	- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement.
J0885	INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS	HCPCS	- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement.
96372	THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR	HCPCS	- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four weeks of treatment and whose hemoglobin level remains < 10g/dL after the four weeks of treatment (or hematocrit < 30%), recommended FDA label starting dose may be increased once by 25%. Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement.
J0881	INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)	HCPCS	Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement. The length of a numeric type data element does not include the optional sign.
J0885	INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS	HCPCS	Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement. The length of a numeric type data element does not include the optional sign.
96372	THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR	HCPCS	Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treatment; unless hemoglobin remains below or subsequently falls to < 10g/dL (or the hematocrit is < 30%) - Continuation and reinstitution of ESA therapy must include dose reduction of 25% from previously administered dose - ESA treatment duration for each course of chemotherapy includes the eight weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regimen ESA treatment is not reasonable and necessary for beneficiaries with certain clinical conditions, either because of a harmful effect of the ESA on their underlying disease or because the underlying disease increases their risk of adverse effects related to using ESA. - For End Stage Renal Disease (ESRD) services, see Noridian's ESRD page under Browse by Specialty - For Drugs, see Noridian's Drugs, Biologicals and Injections under Browse by Topic - For Radiation Oncology, see Noridian's Radiation Oncology page under Browse by Specialty For the treatment of cancer; drugs, not self-administered, include ESA administration HCPCS codes: - J0881 (Darbepoetin Alfa; Aranesp, 1 mcg; non-ESRD use) - J0885 (Epoetin Alfa; Epogen, Procrit, 1000 units; non-ESRD use) All non-ESRD claims billing J0881 and J0885 must be reported with one of the following modifiers: - EA (ESA, anemia, chemo-induced) - Denies diagnosis(es) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia when hemoglobin >10.0g/dL > or hematocrit >30.0% - EB (ESA, anemia, radio-induced) - Denies any claims billed with appended modifier EB - EC (ESA, anemia, non-chemo/radio) - Denies diagnosis(es) for anemia in cancer or cancer treatment patients due to folate deficiency or bone marrow fibrosis, B-12 or iron deficiency, Hemolysis, bleeding, anemia associated with treatment of acute and chronic myelogenous leukemias (CML, AML), erythroid cancers, prophylactic use to prevent chemotherapy induced anemia, reduce tumor hypoxia, Erythropoietin-type resistance due to neutralizing antibodies or uncontrolled hypertension CPT 96372 (therapeutic, prophylactic or diagnostic injection; specify substance or drug; subcutaneous or intramuscular) covers the administration with above J codes. To report test results, follow instructions below with the multiple endocrine adenomatosis (MEA) segment: - Electronic Billing: For electronic claims (ASC X12 837 professional claim format), report hemoglobin or hematocrit readings in Loop 2400 MEA segment. Leading zeros must be suppressed for electronic billing, unless necessary to satisfy a minimum length requirement. The length of a numeric type data element does not include the optional sign.
85025	TTH CBC W/AUTO DIFF-SP	HCPCS	- Three-digit number reported (such as 31.2) = 31.2 - Two-digit number reported (such as 4.5) = 04.5 - Two-digit whole number reported (such as 28) = 28.0 - Single decimal position reported (such as .9) = 00.9 - One-digit whole number reported (such as 7) = 07.0 - Test result reported as 2-digits and 2 decimal places (such as 26.25) = 26.2 Medical records from physician or nonphysician practitioner, must be made available upon request and includes patient counseling with: - Diagnosis and prognosis - Treatment options/plan - Patient's weight in kilograms - Erythropoietin analog units administered per kilogram of body weight - If usual doses exceeding, medical justification of erythropoietin analogs administration - ICD-10 diagnosis alone does not ensure coverage - Side effects and recovery When documenting lab tests, include the treating physician's oncology flow sheet and note verbiage "CBC" or "WBC": - CPT 85025 or the complete blood count (CBC) with automated hemoglobin (Hgb), hematocrit (Hct), red blood cell count (RBC), white blood count (WBC) and platelet count and automated differential WBC count - CPT 85027 without automated differential WBC count - Without valid order, medical necessity not supported Top errors seen when documentation requested: - E/M - missing supportive documentation (i.e., daily and progress notes, evaluation, clinical documentation, etc.) - E/M - documentation supports CPT/HCPCS down coding - Injection/Infusion - documentation does not support medical necessity, missing physician order/intent - Imaging or Lab test - documentation supports CPT/HCPCS code change - Bundled service billed for separate payment - National Coverage Determination (NCD) Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (110.21) - CMS Internet Only Manual (IOM) Publication 100-02, Medicare Benefit Policy, Chapter 15, Sections 50-50.6 and 60; Incident To, Covered Medical Services, Off-label Drugs - CMS IOM Publication 100-04, Medicare Claims Processing, Chapter 12, Section 30.5; Chemotherapy Administration - CMS IOM Publication 100-04, Medicare Claims Processing, Chapter 17, Sections 40 and 100.2.9; Drugs and Biologicals - American Society of Clinical Oncology (ASCO) - CMS Oncology Care Model (OCM) 2016-2021 Last Updated Wed, 16 Dec 2020 20:51:20 +0000 The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

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