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85027 | HEMOGRAM | HCPCS | - Three-digit number reported (such as 31.2) = 31.2
- Two-digit number reported (such as 4.5) = 04.5
- Two-digit whole number reported (such as 28) = 28.0
- Single decimal position reported (such as .9) = 00.9
- One-digit whole number reported (such as 7) = 07.0
- Test result reported as 2-digits and 2 decimal places (such as 26.25) = 26.2
Medical records from physician or nonphysician practitioner, must be made available upon request and includes patient counseling with:
- Diagnosis and prognosis
- Treatment options/plan
- Patient's weight in kilograms
- Erythropoietin analog units administered per kilogram of body weight
- If usual doses exceeding, medical justification of erythropoietin analogs administration
- ICD-10 diagnosis alone does not ensure coverage
- Side effects and recovery
When documenting lab tests, include the treating physician's oncology flow sheet and note verbiage "CBC" or "WBC":
- CPT 85025 or the complete blood count (CBC) with automated hemoglobin (Hgb), hematocrit (Hct), red blood cell count (RBC), white blood count (WBC) and platelet count and automated differential WBC count
- CPT 85027 without automated differential WBC count
- Without valid order, medical necessity not supported
Top errors seen when documentation requested:
- E/M - missing supportive documentation (i.e., daily and progress notes, evaluation, clinical documentation, etc.) - E/M - documentation supports CPT/HCPCS down coding
- Injection/Infusion - documentation does not support medical necessity, missing physician order/intent
- Imaging or Lab test - documentation supports CPT/HCPCS code change
- Bundled service billed for separate payment
- National Coverage Determination (NCD) Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (110.21)
- CMS Internet Only Manual (IOM) Publication 100-02, Medicare Benefit Policy, Chapter 15, Sections 50-50.6 and 60; Incident To, Covered Medical Services, Off-label Drugs
- CMS IOM Publication 100-04, Medicare Claims Processing, Chapter 12, Section 30.5; Chemotherapy Administration
- CMS IOM Publication 100-04, Medicare Claims Processing, Chapter 17, Sections 40 and 100.2.9; Drugs and Biologicals
- American Society of Clinical Oncology (ASCO)
- CMS Oncology Care Model (OCM) 2016-2021
Last Updated Wed, 16 Dec 2020 20:51:20 +0000
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime. |
A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries | HCPCS | 04/12/2010: Description section revised to add the four oncologic applications of PET Scanning; Policy section revised to add indications considered medically necessary for Melanoma, Lymphoma, lung; colorectal; pancreatic; head & neck; esophageal; breast; ovarian and testicular cancers. Added indications considered medically necessary for differentiated thyroid and cervical cancers; added prostate cancer and cancer surveillance as investigational for all indications. Code reference section revised to add the following ICD-9 diagnosis codes to the covered codes table: 140.0 - 140.9; 141.0 - 141.9; 142.0 - 142.9; 143.0 - 143.9; 150.0 -150.9; 151.0 - 151.9, 155.1; 156.0; 156.2; 157.0 -157.9; 158.0 - 158.9; 159.0 - 159.9; 174.0 - 174.5 and 174.8 - 174.9; 175.0; 175.9; 180.0 - 180.9; 180.3 -183.9; 186.0; 186.9; 190.0 - 190.9; 191.0 - 191.9; 193; 194.0 - 194.9; 195.0; 198.3; 198.4; 198.6; 198.7; 198.81; 198.82; 209.00 - 209.03; 209.20 - 209.29; 230.0 - 230.9; 231.0 - 231.0 - 231.9; 233.0; 233.1; 234.0 - 234.9; 236.2; 235.4; 237.5; 239.0; 239.1; 239.3; 239.6; 239.9; 518.89; 784.2; and 795.81. Moved HCPCS Code A9580 from non-covered to covered table. 10/05/2010: Policy reviewed; policy statement unchanged. |
A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries | HCPCS | Added indications considered medically necessary for differentiated thyroid and cervical cancers; added prostate cancer and cancer surveillance as investigational for all indications. Code reference section revised to add the following ICD-9 diagnosis codes to the covered codes table: 140.0 - 140.9; 141.0 - 141.9; 142.0 - 142.9; 143.0 - 143.9; 150.0 -150.9; 151.0 - 151.9, 155.1; 156.0; 156.2; 157.0 -157.9; 158.0 - 158.9; 159.0 - 159.9; 174.0 - 174.5 and 174.8 - 174.9; 175.0; 175.9; 180.0 - 180.9; 180.3 -183.9; 186.0; 186.9; 190.0 - 190.9; 191.0 - 191.9; 193; 194.0 - 194.9; 195.0; 198.3; 198.4; 198.6; 198.7; 198.81; 198.82; 209.00 - 209.03; 209.20 - 209.29; 230.0 - 230.9; 231.0 - 231.0 - 231.9; 233.0; 233.1; 234.0 - 234.9; 236.2; 235.4; 237.5; 239.0; 239.1; 239.3; 239.6; 239.9; 518.89; 784.2; and 795.81. Moved HCPCS Code A9580 from non-covered to covered table. 10/05/2010: Policy reviewed; policy statement unchanged. Removed the following ICD-9 codes from the Covered Codes table to be consistent with the policy statement: 151.0-151.9, 152.0-152.9, 155.0-155.2, 156.0-156.9, 158.0-158.9, 159.0, 159.1, 159.8, 159.9, 194.0-194.9, 197.4, 197.5, 197.8, 198.3, 198.4, 198.6, 198.7, 198.81, 198.82, 209.00, 209.01, 209.02, 209.03, 209.11, 209.20-209.29, 230.2, 231.9, 234.8, 234.9, 235.2, 235.3, 235.4, 784.2, and 795.81. |
A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries | HCPCS | Code reference section revised to add the following ICD-9 diagnosis codes to the covered codes table: 140.0 - 140.9; 141.0 - 141.9; 142.0 - 142.9; 143.0 - 143.9; 150.0 -150.9; 151.0 - 151.9, 155.1; 156.0; 156.2; 157.0 -157.9; 158.0 - 158.9; 159.0 - 159.9; 174.0 - 174.5 and 174.8 - 174.9; 175.0; 175.9; 180.0 - 180.9; 180.3 -183.9; 186.0; 186.9; 190.0 - 190.9; 191.0 - 191.9; 193; 194.0 - 194.9; 195.0; 198.3; 198.4; 198.6; 198.7; 198.81; 198.82; 209.00 - 209.03; 209.20 - 209.29; 230.0 - 230.9; 231.0 - 231.0 - 231.9; 233.0; 233.1; 234.0 - 234.9; 236.2; 235.4; 237.5; 239.0; 239.1; 239.3; 239.6; 239.9; 518.89; 784.2; and 795.81. Moved HCPCS Code A9580 from non-covered to covered table. 10/05/2010: Policy reviewed; policy statement unchanged. Removed the following ICD-9 codes from the Covered Codes table to be consistent with the policy statement: 151.0-151.9, 152.0-152.9, 155.0-155.2, 156.0-156.9, 158.0-158.9, 159.0, 159.1, 159.8, 159.9, 194.0-194.9, 197.4, 197.5, 197.8, 198.3, 198.4, 198.6, 198.7, 198.81, 198.82, 209.00, 209.01, 209.02, 209.03, 209.11, 209.20-209.29, 230.2, 231.9, 234.8, 234.9, 235.2, 235.3, 235.4, 784.2, and 795.81. Corrected typo to change 235.4 to 236.4. |
A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries | HCPCS | Moved HCPCS Code A9580 from non-covered to covered table. 10/05/2010: Policy reviewed; policy statement unchanged. Removed the following ICD-9 codes from the Covered Codes table to be consistent with the policy statement: 151.0-151.9, 152.0-152.9, 155.0-155.2, 156.0-156.9, 158.0-158.9, 159.0, 159.1, 159.8, 159.9, 194.0-194.9, 197.4, 197.5, 197.8, 198.3, 198.4, 198.6, 198.7, 198.81, 198.82, 209.00, 209.01, 209.02, 209.03, 209.11, 209.20-209.29, 230.2, 231.9, 234.8, 234.9, 235.2, 235.3, 235.4, 784.2, and 795.81. Corrected typo to change 235.4 to 236.4. Added 199.1, 209.20, 209.72, and 233.6 to the Covered Codes table. |
95027 | PR INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE | 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 HISTORY9/1992: Issued
2/1997: Revised: Limitation on number of tests; denial of repeat testing except in rare circumstances; moved two tests (nasal and conjunctival challenge) to Investigational list. 4/28/00 See clarification under POLICY. 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. |
95078 | Provocative testing | 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 HISTORY9/1992: Issued
2/1997: Revised: Limitation on number of tests; denial of repeat testing except in rare circumstances; moved two tests (nasal and conjunctival challenge) to Investigational list. 4/28/00 See clarification under POLICY. 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. |
95027 | PR INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE | HCPCS | POLICY HISTORY9/1992: Issued
2/1997: Revised: Limitation on number of tests; denial of repeat testing except in rare circumstances; moved two tests (nasal and conjunctival challenge) to Investigational list. 4/28/00 See clarification under POLICY. 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. |
95078 | Provocative testing | HCPCS | POLICY HISTORY9/1992: Issued
2/1997: Revised: Limitation on number of tests; denial of repeat testing except in rare circumstances; moved two tests (nasal and conjunctival challenge) to Investigational list. 4/28/00 See clarification under POLICY. 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. |
95015 | Id allergy titrate-drug/bug | HCPCS | POLICY HISTORY9/1992: Issued
2/1997: Revised: Limitation on number of tests; denial of repeat testing except in rare circumstances; moved two tests (nasal and conjunctival challenge) to Investigational list. 4/28/00 See clarification under POLICY. 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. |
95027 | PR INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE | HCPCS | 4/28/00 See clarification under POLICY. 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. Additional information regarding Serial Endpoint Testing (SET) added to the description section of the policy. |
95078 | Provocative testing | HCPCS | 4/28/00 See clarification under POLICY. 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. Additional information regarding Serial Endpoint Testing (SET) added to the description section of the policy. |
95015 | Id allergy titrate-drug/bug | HCPCS | 4/28/00 See clarification under POLICY. 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. Additional information regarding Serial Endpoint Testing (SET) added to the description section of the policy. |
95027 | PR INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE | HCPCS | 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. Additional information regarding Serial Endpoint Testing (SET) added to the description section of the policy. Policy statement updated to include medically necessary indcations for Serial Endpoint Testing (SET). |
95078 | Provocative testing | HCPCS | 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. Additional information regarding Serial Endpoint Testing (SET) added to the description section of the policy. Policy statement updated to include medically necessary indcations for Serial Endpoint Testing (SET). |
95015 | Id allergy titrate-drug/bug | HCPCS | 5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added
11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered
2/11/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/5/2002: Code Reference section updated
6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered
11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added
09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy
10/25/2006: Policy updated to include allergy testing limits are per day
12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy
1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET
8/17/2007: Policy section partially re-written for clarity; no change in policy
8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET
12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions
12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
6/16/2009: Policy statement updated. Additional information regarding Serial Endpoint Testing (SET) added to the description section of the policy. Policy statement updated to include medically necessary indcations for Serial Endpoint Testing (SET). |
20694 | Rmvl ext fixj sys under anes | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21206 | Reconstruct upper jaw bone | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
42200 | Reconstruct cleft palate | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D6199 | PR UNSPEC IMPLANT PROCEDURE BY REPORT | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21196 | Reconst lwr jaw w/fixation | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21247 | Reconstruct lower jaw bone | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D8999 | PR UNS ORTHODONTIC PROCEDURE BY REPORT | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20693 | PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D8010 | PR LTD ORTHODONT TX PRIMARY DENTITION | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
30462 | Revision of nose | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21110 | PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
0232T | Njx platelet plasma | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21210 | PR GRAFT BONE NASAL/MAXILLARY/MALAR AREAS | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20696 | PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT 1ST&SUBSQ | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
30400 | Reconstruction of nose | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21120 | Reconstruction of chin | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20692 | PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
38220 | PR DIAGNOSTIC BONE MARROW ASPIRATIONS | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D7949 | Reconstruct midface w/graft | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
42225 | Reconstruct cleft palate | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20697 | PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D6010 | PR SURG PLCMT IMPL BODY: ENDOSTEAL | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
S9055 | Procuren or other growth fac | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D7946 | Reconstruction maxilla total | HCPCS | The authors concluded that injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dento-alveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density. These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20694 | Rmvl ext fixj sys under anes | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21206 | Reconstruct upper jaw bone | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
42200 | Reconstruct cleft palate | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D6199 | PR UNSPEC IMPLANT PROCEDURE BY REPORT | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21196 | Reconst lwr jaw w/fixation | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21247 | Reconstruct lower jaw bone | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D8999 | PR UNS ORTHODONTIC PROCEDURE BY REPORT | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20693 | PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D8010 | PR LTD ORTHODONT TX PRIMARY DENTITION | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
30462 | Revision of nose | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21110 | PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
0232T | Njx platelet plasma | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21210 | PR GRAFT BONE NASAL/MAXILLARY/MALAR AREAS | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20696 | PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT 1ST&SUBSQ | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
30400 | Reconstruction of nose | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
21120 | Reconstruction of chin | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20692 | PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
38220 | PR DIAGNOSTIC BONE MARROW ASPIRATIONS | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D7949 | Reconstruct midface w/graft | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
42225 | Reconstruct cleft palate | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
20697 | PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D6010 | PR SURG PLCMT IMPL BODY: ENDOSTEAL | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
S9055 | Procuren or other growth fac | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
D7946 | Reconstruction maxilla total | HCPCS | These preliminary findings from a canine model need to be examined in human subjects. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device| |
1745 | Thoracoscopic robotic assisted procedure | ICD | The Monmouth and Ocean County breast cancer death rate in the past two decades was 20.1% above the U.S., but 4.5% below for all causes other than cancer (Table 5). These differences are consistent for young, middle-aged, and older women. Mortality, Monmouth/Ocean Counties vs. U.S.
From Cancer and From All Other Causes, 1985-2003
|All Cancers||Cancer||% Local is +/- U.S.|
|Age 0-14||133||+13.4||– 31.7|
|Age 15-44||1745||+12.0||– 16.4|
|All- Whites||51430||+10.7||– 3.8|
|All- Blacks||2478||+ 5.3||+ 0.4|
|Breast Cancer (white females)|
|Age 25-44||263||+19.6||– 12.9|
|Age 45-64||1223||+18.9||– 5.0|
|Age 65+||3000||+21.7||– 3.2|
|All Ages||4486||+20.1||– 4.5|
|Source: U.S. Centers for Disease Control and Prevention, http://wonder.cdc.gov, underlying cause of death. Uses ICD-9 cancer codes 140.0-208.9 (1994-1998) and ICD-10 cancer codes C00-C97.9 (1999-2003). Uses ICD-9 breast cancer codes 174.0-174.9 (1994-1998) and ICD-10 cancer codes C50-C50.9 (1999-2003). |
1745 | Thoracoscopic robotic assisted procedure | ICD | These differences are consistent for young, middle-aged, and older women. Mortality, Monmouth/Ocean Counties vs. U.S.
From Cancer and From All Other Causes, 1985-2003
|All Cancers||Cancer||% Local is +/- U.S.|
|Age 0-14||133||+13.4||– 31.7|
|Age 15-44||1745||+12.0||– 16.4|
|All- Whites||51430||+10.7||– 3.8|
|All- Blacks||2478||+ 5.3||+ 0.4|
|Breast Cancer (white females)|
|Age 25-44||263||+19.6||– 12.9|
|Age 45-64||1223||+18.9||– 5.0|
|Age 65+||3000||+21.7||– 3.2|
|All Ages||4486||+20.1||– 4.5|
|Source: U.S. Centers for Disease Control and Prevention, http://wonder.cdc.gov, underlying cause of death. Uses ICD-9 cancer codes 140.0-208.9 (1994-1998) and ICD-10 cancer codes C00-C97.9 (1999-2003). Uses ICD-9 breast cancer codes 174.0-174.9 (1994-1998) and ICD-10 cancer codes C50-C50.9 (1999-2003). All age data adjusted to 2000 U.S. standard population. |
1745 | Thoracoscopic robotic assisted procedure | ICD | Mortality, Monmouth/Ocean Counties vs. U.S.
From Cancer and From All Other Causes, 1985-2003
|All Cancers||Cancer||% Local is +/- U.S.|
|Age 0-14||133||+13.4||– 31.7|
|Age 15-44||1745||+12.0||– 16.4|
|All- Whites||51430||+10.7||– 3.8|
|All- Blacks||2478||+ 5.3||+ 0.4|
|Breast Cancer (white females)|
|Age 25-44||263||+19.6||– 12.9|
|Age 45-64||1223||+18.9||– 5.0|
|Age 65+||3000||+21.7||– 3.2|
|All Ages||4486||+20.1||– 4.5|
|Source: U.S. Centers for Disease Control and Prevention, http://wonder.cdc.gov, underlying cause of death. Uses ICD-9 cancer codes 140.0-208.9 (1994-1998) and ICD-10 cancer codes C00-C97.9 (1999-2003). Uses ICD-9 breast cancer codes 174.0-174.9 (1994-1998) and ICD-10 cancer codes C50-C50.9 (1999-2003). All age data adjusted to 2000 U.S. standard population. All differences statistically significant at p<.05 except for all cancers for blacks.|
The five most common causes of death (circulatory disease, cancer, respiratory disease, accidents/suicide/homicide, and nervous system diseases) account for about 83% of all death nationally. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | For this procedure, we’d code 35471 for “transluminal balloon angioplasty, percutaneous; renal or other visceral artery,” and we’d add the modifier -66 for “surgical team.” So we’d end up with 35471-66. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Physical Status Modifier (For Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
These are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
These are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. In this webinar, you will learn about the 143 deleted codes and why they were given the boot. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. In this webinar, you will learn about the 143 deleted codes and why they were given the boot. You will also learn the 264 New codes and when to use them and if they replaced older codes and more. |
90674 | HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
9065 | Argatroban esrd dialysis | APC | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
9067 | Lutetium lu 177 dotatat t | APC | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90662 | INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE, ENHANCED IMMUNOGENICITY VIA INCREASED ANTIGEN CONTENT, FOR INTRAMUSCULAR USE | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90685 | HC IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90656 | HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
9075 | Inj, kovaltry, 1 i.u. | APC | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
Q2035 | PR AFLURIA VACC, 3 YRS & >, IM | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90688 | HC IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90687 | Iiv4 vaccine splt 0.25 ml im | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90756 | PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
G0008 | PR ADMIN INFLUENZA VIRUS VAC | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
9068 | Smallpox&monkeypox vac 0. | APC | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90689 | HC IIV4 VACC INACTIVATED PRSRV FR 0.25ML DOS IM US | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90686 | INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, PRESERVATIVE FREE, 0.5 ML DOSAGE, FOR INTRAMUSCULAR USE | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90682 | HC RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM | HCPCS | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
2035 | Auto cell process sys | APC | The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived. - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. |
90674 | HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE | HCPCS | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
9065 | Argatroban esrd dialysis | APC | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
9067 | Lutetium lu 177 dotatat t | APC | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
90662 | INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE, ENHANCED IMMUNOGENICITY VIA INCREASED ANTIGEN CONTENT, FOR INTRAMUSCULAR USE | HCPCS | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
90685 | HC IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE | HCPCS | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
90656 | HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE | HCPCS | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
9075 | Inj, kovaltry, 1 i.u. | APC | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
Q2035 | PR AFLURIA VACC, 3 YRS & >, IM | HCPCS | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
90688 | HC IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE | HCPCS | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
90687 | Iiv4 vaccine splt 0.25 ml im | HCPCS | - Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. |
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