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96117 | NEUROPSYCH TEST BATTERY | CPT | References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
96115 | Neurobehavior status exam | HCPCS | References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
| || || |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing| |
96117 | NEUROPSYCH TEST BATTERY | CPT | References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
| || || |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing| |
1745 | Thoracoscopic robotic assisted procedure | ICD | PMID 17141745. doi:10.1016/j.biopsych.2006.08.041. - World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | The Healthcare Common Procedure Coding System (HCPCS) is a two-tiered system that includes Common Procedure Terminology, at Level I, which is usually referred to as CPT codes. More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. For this reason, both medical billers and medical coders need a solid understanding of how these codes are meant to be used, the kind of understanding that can only be gained through a formal education program of study. |
1999 | ANESTHESIOLOGY GROUP | CPT | POLICY HISTORY3/2003: Approved by Medical Policy Advisory Committee (MPAC)
12/17/2003: Code Reference section updated, CPT code 58900, 58920, 58925, 58943, 58950, 58951, 58952, 58953, 58954, 58960 deleted, ICD-9 procedure code 65.01, 65.09 deleted, ICD-9 diagnosis code 183.0, V16.40 deleted
09/22/2006: Coding updated. ICD9 2006 revisions added to policy
12/31/2008: Policy reviewed, no changes. 08/28/2015: Code Reference section updated for ICD-10. Added ICD-9 diagnosis codes V84.01 and V84.02. Hayes Medical Technology Directory
ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician-Gynecologists, Number 7, September 1999
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
1743 | Percutaneous robotic assisted procedure | ICD | 2010, 7, 1720–1743. [Google Scholar] [CrossRef]
- Good Health Adds Life to Years. Global Brief for World Health Day 2012; WHO: Geneva, Switzerland, 2012. - Giannangelo, K.; Millar, J. Mapping SNOMED CT to ICD-10. Stud. |
20987 | Cptr-asst dir ms px pre img | CPT | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY1/17/2008: Policy added
12/29/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
1/8/2009: Policy reviewed, no changes
6/23/2010: Description section revised. FEP verbiage was added to Policy Exceptions section. Code Reference section revised to remove CPT Codes 20986 and 20987 because the codes were deleted 12/31/2008. |
20986 | Cptr-asst dir ms px io img | CPT | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY1/17/2008: Policy added
12/29/2008: Code reference section updated per the 2009 CPT/HCPCS revisions
1/8/2009: Policy reviewed, no changes
6/23/2010: Description section revised. FEP verbiage was added to Policy Exceptions section. Code Reference section revised to remove CPT Codes 20986 and 20987 because the codes were deleted 12/31/2008. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | HCPCS Level III contains alphanumeric codes that are assigned
by Medicaid state agencies to identify additional items
and services not included in levels I or II. These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three levels, with the WA - ZY range used for locally
assigned procedure modifiers. - Health Insurance Portability &
Accountability Act (HIPAA) – A law passed
in 1996 which is also sometimes called the “Kassebaum-Kennedy”
law. This law expands healthcare coverage for patients who
have lost or changed jobs, or have pre-existing conditions. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three levels, with the WA - ZY range used for locally
assigned procedure modifiers. - Health Insurance Portability &
Accountability Act (HIPAA) – A law passed
in 1996 which is also sometimes called the “Kassebaum-Kennedy”
law. This law expands healthcare coverage for patients who
have lost or changed jobs, or have pre-existing conditions. HIPAA does not replace the states' roles as primary regulators
of insurance. |
90838 | Psytx w pt w e/m 60 min | HCPCS | As tinnitus-retraining therapy in part involves counseling, an individual psychotherapy CPT code may be used (code range 90832–90838). Tinnitus-retraining therapy may also be billed as physical or speech therapy. There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. |
97026 | PR APPLICATION MODALITY 1/> AREAS INFRARED | HCPCS | As tinnitus-retraining therapy in part involves counseling, an individual psychotherapy CPT code may be used (code range 90832–90838). Tinnitus-retraining therapy may also be billed as physical or speech therapy. There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. |
S8948 | Low-level laser trmt 15 min | HCPCS | As tinnitus-retraining therapy in part involves counseling, an individual psychotherapy CPT code may be used (code range 90832–90838). Tinnitus-retraining therapy may also be billed as physical or speech therapy. There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. |
90832 | Psytx w pt 30 minutes | HCPCS | As tinnitus-retraining therapy in part involves counseling, an individual psychotherapy CPT code may be used (code range 90832–90838). Tinnitus-retraining therapy may also be billed as physical or speech therapy. There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. |
97026 | PR APPLICATION MODALITY 1/> AREAS INFRARED | HCPCS | Tinnitus-retraining therapy may also be billed as physical or speech therapy. There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). |
S8948 | Low-level laser trmt 15 min | HCPCS | Tinnitus-retraining therapy may also be billed as physical or speech therapy. There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). |
E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation | HCPCS | Tinnitus-retraining therapy may also be billed as physical or speech therapy. There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). |
97026 | PR APPLICATION MODALITY 1/> AREAS INFRARED | HCPCS | There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). Tinnitus-masking devices represent a piece of durable medical equipment. |
S8948 | Low-level laser trmt 15 min | HCPCS | There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). Tinnitus-masking devices represent a piece of durable medical equipment. |
E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation | HCPCS | There is no specific CPT code for low-level laser therapy. However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). Tinnitus-masking devices represent a piece of durable medical equipment. |
97026 | PR APPLICATION MODALITY 1/> AREAS INFRARED | HCPCS | However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). Tinnitus-masking devices represent a piece of durable medical equipment. There is currently no specific HCPCS code describing these devices. |
S8948 | Low-level laser trmt 15 min | HCPCS | However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). Tinnitus-masking devices represent a piece of durable medical equipment. There is currently no specific HCPCS code describing these devices. |
E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation | HCPCS | However, providers may elect to use CPT code 97026 (application of a modality; infrared), since the laser emits light in the infrared spectrum. In January 2004, a HCPCS code (S8948) was added that is specific to low-level laser therapy. As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). Tinnitus-masking devices represent a piece of durable medical equipment. There is currently no specific HCPCS code describing these devices. |
E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation | HCPCS | As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). Tinnitus-masking devices represent a piece of durable medical equipment. There is currently no specific HCPCS code describing these devices. There is a specific CPT code for tinnitus assessment –
92625: Assessment of tinnitus (includes pitch, loudness matching, and masking)
BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity. This policy was created in 2001 and updated periodically using the MEDLINE database. |
92625 | Tinnitus assessment | HCPCS | As described in the literature, electrical stimulation is an office-based procedure, but if self-administered by the patient, the device could possibly be described by HCPCS code E0720 (transcutaneous electrical nerve stimulation [TENS] device, 2 lead, localized stimulation). Tinnitus-masking devices represent a piece of durable medical equipment. There is currently no specific HCPCS code describing these devices. There is a specific CPT code for tinnitus assessment –
92625: Assessment of tinnitus (includes pitch, loudness matching, and masking)
BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity. This policy was created in 2001 and updated periodically using the MEDLINE database. |
92625 | Tinnitus assessment | HCPCS | Tinnitus-masking devices represent a piece of durable medical equipment. There is currently no specific HCPCS code describing these devices. There is a specific CPT code for tinnitus assessment –
92625: Assessment of tinnitus (includes pitch, loudness matching, and masking)
BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity. This policy was created in 2001 and updated periodically using the MEDLINE database. The most recent review was performed through April 3, 2014. |
92625 | Tinnitus assessment | HCPCS | There is currently no specific HCPCS code describing these devices. There is a specific CPT code for tinnitus assessment –
92625: Assessment of tinnitus (includes pitch, loudness matching, and masking)
BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity. This policy was created in 2001 and updated periodically using the MEDLINE database. The most recent review was performed through April 3, 2014. Because tinnitus is a subjective symptom without a known physiologic explanation, randomized placebo- controlled trials are particularly important to validate the effectiveness of any treatment compared with the expected placebo effect. |
S8948 | Low-level laser trmt 15 min | HCPCS | - Stidham KR, Solomon PH, Roberson JB. Evaluation of botulinum toxin A in treatment of tinnitus. Otolaryngol Head Neck Surg 2005; 132(6):883-9. |CPT||No specific CPT codes; see Policy Guidelines|
|ICD-9 Diagnosis||Investigational for all relevant diagnoses|
|HCPCS||S8948||Application of a modality (requiring constant provider attendance) to one or more areas; low level laser; each 15 minutes|
|ICD-10-CM (effective 10/1/15)||Investigational for all relevant diagnoses|
|H93.11-H93.19||Tinnitus code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There are no specific ICD-10-PCS codes for these procedures.|
|Type of Service||Medicine|
|Place of Service||Physician’s Office|
Masking Device, Tinnitus
Tinnitus, Treatment of
|08/15/01||Add to Therapy section||New policy|
|12/30/02||Replace policy||Literature review update; transmeatal irradiation added; no change in policy statement|
|04/29/03||Replace policy||Policy updated with literature search extending from January 2001 to December 2002; policy statement unchanged|
|03/15/05||Replace policy||Literature review updated for the period of December 2002 through December 2004; references added. |
S8948 | Low-level laser trmt 15 min | HCPCS | Evaluation of botulinum toxin A in treatment of tinnitus. Otolaryngol Head Neck Surg 2005; 132(6):883-9. |CPT||No specific CPT codes; see Policy Guidelines|
|ICD-9 Diagnosis||Investigational for all relevant diagnoses|
|HCPCS||S8948||Application of a modality (requiring constant provider attendance) to one or more areas; low level laser; each 15 minutes|
|ICD-10-CM (effective 10/1/15)||Investigational for all relevant diagnoses|
|H93.11-H93.19||Tinnitus code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There are no specific ICD-10-PCS codes for these procedures.|
|Type of Service||Medicine|
|Place of Service||Physician’s Office|
Masking Device, Tinnitus
Tinnitus, Treatment of
|08/15/01||Add to Therapy section||New policy|
|12/30/02||Replace policy||Literature review update; transmeatal irradiation added; no change in policy statement|
|04/29/03||Replace policy||Policy updated with literature search extending from January 2001 to December 2002; policy statement unchanged|
|03/15/05||Replace policy||Literature review updated for the period of December 2002 through December 2004; references added. Added electromagnetic energy to the investigational policy statement|
|04/25/06||Replace policy||Literature review updated for the period of December 2004 through March 2006; transcranial magnetic stimulation and botulinum toxin A injections added to the investigational policy statement|
|02/14/08||Replace policy||Policy updated with literature search; references 17-20 added; policy statement unchanged|
|04/24/09||Replace policy||Policy updated with literature search through March 2009; references added and reordered; policy statement unchanged|
|05/13/10||Replace policy||Policy updated with literature search through April 2010; references added and reordered; policy statement unchanged|
|5/12/11||Replace policy||Policy updated with literature search through March 2011; references added and reordered; policy statement unchanged|
|5/10/12||Replace policy||Policy updated with literature search through March 2012; references added and reordered; some references removed; policy statement unchanged|
|5/09/13||Replace policy||Policy updated with literature search through April 18, 2013; references 1, 7, 24, and 29 added and references reordered; policy statement unchanged|
|5/22/14||Replace policy||Policy updated with literature review through April 3, 2014; references 1, 5, and 28 added; policy statement unchanged.| |
S8948 | Low-level laser trmt 15 min | HCPCS | Otolaryngol Head Neck Surg 2005; 132(6):883-9. |CPT||No specific CPT codes; see Policy Guidelines|
|ICD-9 Diagnosis||Investigational for all relevant diagnoses|
|HCPCS||S8948||Application of a modality (requiring constant provider attendance) to one or more areas; low level laser; each 15 minutes|
|ICD-10-CM (effective 10/1/15)||Investigational for all relevant diagnoses|
|H93.11-H93.19||Tinnitus code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There are no specific ICD-10-PCS codes for these procedures.|
|Type of Service||Medicine|
|Place of Service||Physician’s Office|
Masking Device, Tinnitus
Tinnitus, Treatment of
|08/15/01||Add to Therapy section||New policy|
|12/30/02||Replace policy||Literature review update; transmeatal irradiation added; no change in policy statement|
|04/29/03||Replace policy||Policy updated with literature search extending from January 2001 to December 2002; policy statement unchanged|
|03/15/05||Replace policy||Literature review updated for the period of December 2002 through December 2004; references added. Added electromagnetic energy to the investigational policy statement|
|04/25/06||Replace policy||Literature review updated for the period of December 2004 through March 2006; transcranial magnetic stimulation and botulinum toxin A injections added to the investigational policy statement|
|02/14/08||Replace policy||Policy updated with literature search; references 17-20 added; policy statement unchanged|
|04/24/09||Replace policy||Policy updated with literature search through March 2009; references added and reordered; policy statement unchanged|
|05/13/10||Replace policy||Policy updated with literature search through April 2010; references added and reordered; policy statement unchanged|
|5/12/11||Replace policy||Policy updated with literature search through March 2011; references added and reordered; policy statement unchanged|
|5/10/12||Replace policy||Policy updated with literature search through March 2012; references added and reordered; some references removed; policy statement unchanged|
|5/09/13||Replace policy||Policy updated with literature search through April 18, 2013; references 1, 7, 24, and 29 added and references reordered; policy statement unchanged|
|5/22/14||Replace policy||Policy updated with literature review through April 3, 2014; references 1, 5, and 28 added; policy statement unchanged.| |
S8948 | Low-level laser trmt 15 min | HCPCS | |CPT||No specific CPT codes; see Policy Guidelines|
|ICD-9 Diagnosis||Investigational for all relevant diagnoses|
|HCPCS||S8948||Application of a modality (requiring constant provider attendance) to one or more areas; low level laser; each 15 minutes|
|ICD-10-CM (effective 10/1/15)||Investigational for all relevant diagnoses|
|H93.11-H93.19||Tinnitus code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There are no specific ICD-10-PCS codes for these procedures.|
|Type of Service||Medicine|
|Place of Service||Physician’s Office|
Masking Device, Tinnitus
Tinnitus, Treatment of
|08/15/01||Add to Therapy section||New policy|
|12/30/02||Replace policy||Literature review update; transmeatal irradiation added; no change in policy statement|
|04/29/03||Replace policy||Policy updated with literature search extending from January 2001 to December 2002; policy statement unchanged|
|03/15/05||Replace policy||Literature review updated for the period of December 2002 through December 2004; references added. Added electromagnetic energy to the investigational policy statement|
|04/25/06||Replace policy||Literature review updated for the period of December 2004 through March 2006; transcranial magnetic stimulation and botulinum toxin A injections added to the investigational policy statement|
|02/14/08||Replace policy||Policy updated with literature search; references 17-20 added; policy statement unchanged|
|04/24/09||Replace policy||Policy updated with literature search through March 2009; references added and reordered; policy statement unchanged|
|05/13/10||Replace policy||Policy updated with literature search through April 2010; references added and reordered; policy statement unchanged|
|5/12/11||Replace policy||Policy updated with literature search through March 2011; references added and reordered; policy statement unchanged|
|5/10/12||Replace policy||Policy updated with literature search through March 2012; references added and reordered; some references removed; policy statement unchanged|
|5/09/13||Replace policy||Policy updated with literature search through April 18, 2013; references 1, 7, 24, and 29 added and references reordered; policy statement unchanged|
|5/22/14||Replace policy||Policy updated with literature review through April 3, 2014; references 1, 5, and 28 added; policy statement unchanged.| |
48556 | Removal allograft pancreas | HCPCS | Although there are no standard guidelines regarding multiple pancreas transplants, the following information may aid in case review:
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
48551 | Prep donor pancreas | HCPCS | Although there are no standard guidelines regarding multiple pancreas transplants, the following information may aid in case review:
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
S2065 | SIMULT PANC KIDN TRANS | HCPCS | Although there are no standard guidelines regarding multiple pancreas transplants, the following information may aid in case review:
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
48552 | Prep donor pancreas/venous | HCPCS | Although there are no standard guidelines regarding multiple pancreas transplants, the following information may aid in case review:
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | Although there are no standard guidelines regarding multiple pancreas transplants, the following information may aid in case review:
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
48556 | Removal allograft pancreas | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
48551 | Prep donor pancreas | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
S2065 | SIMULT PANC KIDN TRANS | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
48552 | Prep donor pancreas/venous | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
S2152 | SOLID ORGAN TRANSPL PKG | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
48556 | Removal allograft pancreas | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
48551 | Prep donor pancreas | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
S2065 | SIMULT PANC KIDN TRANS | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
48552 | Prep donor pancreas/venous | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
48556 | Removal allograft pancreas | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
48551 | Prep donor pancreas | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
S2065 | SIMULT PANC KIDN TRANS | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
48552 | Prep donor pancreas/venous | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
V2799 | Misc vision item or service | HCPCS | PMID 19874111
- Vision, learning and dyslexia. A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997;
Accessed November, 2014. |CPT||92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|ICD-9 Procedure||95.35||Orthoptic training|
|ICD-9 Diagnosis||315.00-315.09||Developmental reading disorder coding range|
|378.83||Other disorders of binocular eye movements; converge insufficiency or palsy|
|HCPCS||V2799||Vision service, miscellaneous|
|ICD-10-CM (effective 10/1/15)||H51.11 -H51.12||Convergence insufficiency and excess code range|
|F81.0||Specific reading disorder|
|ICD-10-CM (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. |
92065 | PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP | HCPCS | PMID 19874111
- Vision, learning and dyslexia. A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997;
Accessed November, 2014. |CPT||92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|ICD-9 Procedure||95.35||Orthoptic training|
|ICD-9 Diagnosis||315.00-315.09||Developmental reading disorder coding range|
|378.83||Other disorders of binocular eye movements; converge insufficiency or palsy|
|HCPCS||V2799||Vision service, miscellaneous|
|ICD-10-CM (effective 10/1/15)||H51.11 -H51.12||Convergence insufficiency and excess code range|
|F81.0||Specific reading disorder|
|ICD-10-CM (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. |
V2799 | Misc vision item or service | HCPCS | A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997;
Accessed November, 2014. |CPT||92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|ICD-9 Procedure||95.35||Orthoptic training|
|ICD-9 Diagnosis||315.00-315.09||Developmental reading disorder coding range|
|378.83||Other disorders of binocular eye movements; converge insufficiency or palsy|
|HCPCS||V2799||Vision service, miscellaneous|
|ICD-10-CM (effective 10/1/15)||H51.11 -H51.12||Convergence insufficiency and excess code range|
|F81.0||Specific reading disorder|
|ICD-10-CM (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.|
|Type of Service||Vision|
|Place of Service||Physician’s Office|
|7/31/96||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature search; new review date only|
|12/17/03||Replace policy||Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section|
|03/15/05||Replace policy||Policy reviewed with literature search; policy statement unchanged|
|03/7/06||Replace policy||Policy reviewed with literature search; no change in policy statement|
|01/10/08||Replace Policy||Policy reviewed with literature search; reference 10 added; no change in policy statement.|
|03/12/09||Replace policy||Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.|
|01/13/11||Replace policy||Policy updated with literature review; references added and reordered, clinical input reviewed. |
92065 | PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP | HCPCS | A joint organizational policy statement of the American Academy of Optometry and the American Optometric Association. 1997;
Accessed November, 2014. |CPT||92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|ICD-9 Procedure||95.35||Orthoptic training|
|ICD-9 Diagnosis||315.00-315.09||Developmental reading disorder coding range|
|378.83||Other disorders of binocular eye movements; converge insufficiency or palsy|
|HCPCS||V2799||Vision service, miscellaneous|
|ICD-10-CM (effective 10/1/15)||H51.11 -H51.12||Convergence insufficiency and excess code range|
|F81.0||Specific reading disorder|
|ICD-10-CM (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.|
|Type of Service||Vision|
|Place of Service||Physician’s Office|
|7/31/96||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature search; new review date only|
|12/17/03||Replace policy||Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section|
|03/15/05||Replace policy||Policy reviewed with literature search; policy statement unchanged|
|03/7/06||Replace policy||Policy reviewed with literature search; no change in policy statement|
|01/10/08||Replace Policy||Policy reviewed with literature search; reference 10 added; no change in policy statement.|
|03/12/09||Replace policy||Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.|
|01/13/11||Replace policy||Policy updated with literature review; references added and reordered, clinical input reviewed. |
V2799 | Misc vision item or service | HCPCS | 1997;
Accessed November, 2014. |CPT||92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|ICD-9 Procedure||95.35||Orthoptic training|
|ICD-9 Diagnosis||315.00-315.09||Developmental reading disorder coding range|
|378.83||Other disorders of binocular eye movements; converge insufficiency or palsy|
|HCPCS||V2799||Vision service, miscellaneous|
|ICD-10-CM (effective 10/1/15)||H51.11 -H51.12||Convergence insufficiency and excess code range|
|F81.0||Specific reading disorder|
|ICD-10-CM (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.|
|Type of Service||Vision|
|Place of Service||Physician’s Office|
|7/31/96||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature search; new review date only|
|12/17/03||Replace policy||Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section|
|03/15/05||Replace policy||Policy reviewed with literature search; policy statement unchanged|
|03/7/06||Replace policy||Policy reviewed with literature search; no change in policy statement|
|01/10/08||Replace Policy||Policy reviewed with literature search; reference 10 added; no change in policy statement.|
|03/12/09||Replace policy||Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.|
|01/13/11||Replace policy||Policy updated with literature review; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary|
|1/12/12||Replace policy||Policy updated with literature search through November 2011; references added and reordered; policy statements unchanged|
|1/10/13||Replace policy||Policy updated with literature search through November 2012; policy statements unchanged|
|1/09/14||Replace policy||Policy updated with literature search through December 4, 2013; references 12 and 18 added. |
92065 | PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP | HCPCS | 1997;
Accessed November, 2014. |CPT||92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|ICD-9 Procedure||95.35||Orthoptic training|
|ICD-9 Diagnosis||315.00-315.09||Developmental reading disorder coding range|
|378.83||Other disorders of binocular eye movements; converge insufficiency or palsy|
|HCPCS||V2799||Vision service, miscellaneous|
|ICD-10-CM (effective 10/1/15)||H51.11 -H51.12||Convergence insufficiency and excess code range|
|F81.0||Specific reading disorder|
|ICD-10-CM (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.|
|Type of Service||Vision|
|Place of Service||Physician’s Office|
|7/31/96||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature search; new review date only|
|12/17/03||Replace policy||Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section|
|03/15/05||Replace policy||Policy reviewed with literature search; policy statement unchanged|
|03/7/06||Replace policy||Policy reviewed with literature search; no change in policy statement|
|01/10/08||Replace Policy||Policy reviewed with literature search; reference 10 added; no change in policy statement.|
|03/12/09||Replace policy||Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.|
|01/13/11||Replace policy||Policy updated with literature review; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary|
|1/12/12||Replace policy||Policy updated with literature search through November 2011; references added and reordered; policy statements unchanged|
|1/10/13||Replace policy||Policy updated with literature search through November 2012; policy statements unchanged|
|1/09/14||Replace policy||Policy updated with literature search through December 4, 2013; references 12 and 18 added. |
V2799 | Misc vision item or service | HCPCS | |CPT||92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|ICD-9 Procedure||95.35||Orthoptic training|
|ICD-9 Diagnosis||315.00-315.09||Developmental reading disorder coding range|
|378.83||Other disorders of binocular eye movements; converge insufficiency or palsy|
|HCPCS||V2799||Vision service, miscellaneous|
|ICD-10-CM (effective 10/1/15)||H51.11 -H51.12||Convergence insufficiency and excess code range|
|F81.0||Specific reading disorder|
|ICD-10-CM (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.|
|Type of Service||Vision|
|Place of Service||Physician’s Office|
|7/31/96||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature search; new review date only|
|12/17/03||Replace policy||Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section|
|03/15/05||Replace policy||Policy reviewed with literature search; policy statement unchanged|
|03/7/06||Replace policy||Policy reviewed with literature search; no change in policy statement|
|01/10/08||Replace Policy||Policy reviewed with literature search; reference 10 added; no change in policy statement.|
|03/12/09||Replace policy||Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.|
|01/13/11||Replace policy||Policy updated with literature review; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary|
|1/12/12||Replace policy||Policy updated with literature search through November 2011; references added and reordered; policy statements unchanged|
|1/10/13||Replace policy||Policy updated with literature search through November 2012; policy statements unchanged|
|1/09/14||Replace policy||Policy updated with literature search through December 4, 2013; references 12 and 18 added. Policy statements unchanged.|
|1/15/15||Replace policy||Policy updated with literature review through December 3, 2014; references 22 and 25 added. |
92065 | PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP | HCPCS | |CPT||92065||Orthoptic and/or pleoptic training, with continuing medical direction and evaluation|
|ICD-9 Procedure||95.35||Orthoptic training|
|ICD-9 Diagnosis||315.00-315.09||Developmental reading disorder coding range|
|378.83||Other disorders of binocular eye movements; converge insufficiency or palsy|
|HCPCS||V2799||Vision service, miscellaneous|
|ICD-10-CM (effective 10/1/15)||H51.11 -H51.12||Convergence insufficiency and excess code range|
|F81.0||Specific reading disorder|
|ICD-10-CM (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.|
|Type of Service||Vision|
|Place of Service||Physician’s Office|
|7/31/96||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature search; new review date only|
|12/17/03||Replace policy||Policy reviewed with literature search; policy statement unchanged; additional discussion and references in Rationale section|
|03/15/05||Replace policy||Policy reviewed with literature search; policy statement unchanged|
|03/7/06||Replace policy||Policy reviewed with literature search; no change in policy statement|
|01/10/08||Replace Policy||Policy reviewed with literature search; reference 10 added; no change in policy statement.|
|03/12/09||Replace policy||Policy reviewed with literature search from January 2008 through January 2009; no change in policy statement.|
|01/13/11||Replace policy||Policy updated with literature review; references added and reordered, clinical input reviewed. New medically necessary statement added for convergence insufficiency; policy statement for learning disabilities changed to not medically necessary|
|1/12/12||Replace policy||Policy updated with literature search through November 2011; references added and reordered; policy statements unchanged|
|1/10/13||Replace policy||Policy updated with literature search through November 2012; policy statements unchanged|
|1/09/14||Replace policy||Policy updated with literature search through December 4, 2013; references 12 and 18 added. Policy statements unchanged.|
|1/15/15||Replace policy||Policy updated with literature review through December 3, 2014; references 22 and 25 added. |
E0607 | Home blood glucose monitor | HCPCS | Orthotics focuses on creating custom-made braces or devices designed to support, align, or correct muscular-skeletal issues, such as orthopedic shoe inserts or back braces. Prosthetics and orthotics offer highly personalized solutions tailored to patients’ unique needs – helping restore functionality, mobility, and independence in daily lives. Supplies used in the delivery of healthcare
In the context of ObGyn, HCPCS codes might come into play when billing for services that fall outside the scope of CPT codes. For example, the HCPCS code E0607 is used for a home uterine activity monitor. Medical billing codes play a vital role, ensuring smooth communication between healthcare providers, insurers, and researchers. |
E0607 | Home blood glucose monitor | HCPCS | Prosthetics and orthotics offer highly personalized solutions tailored to patients’ unique needs – helping restore functionality, mobility, and independence in daily lives. Supplies used in the delivery of healthcare
In the context of ObGyn, HCPCS codes might come into play when billing for services that fall outside the scope of CPT codes. For example, the HCPCS code E0607 is used for a home uterine activity monitor. Medical billing codes play a vital role, ensuring smooth communication between healthcare providers, insurers, and researchers. CPT, ICD-10, and HCPCS codes are the cornerstones of this system, each serving a unique purpose in accurately documenting and billing for medical services. |
E0607 | Home blood glucose monitor | HCPCS | For example, the HCPCS code E0607 is used for a home uterine activity monitor. Medical billing codes play a vital role, ensuring smooth communication between healthcare providers, insurers, and researchers. CPT, ICD-10, and HCPCS codes are the cornerstones of this system, each serving a unique purpose in accurately documenting and billing for medical services. While CPT codes focus on procedures and services, ICD-10 codes help diagnose conditions, and HCPCS codes encompass various supplies and equipment. These coding systems are indispensable in Obstetrics and Gynecology (ObGyn) and countless other medical specialties, providing the necessary precision for billing and patient care. |
A5120 | Skin barrier, wipes or swabs, each | HCPCS | HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. |
K0011 | Stnd wt pwr whlchr w control | HCPCS | HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. |
Q4011 | Cast sup sht arm ped plaster | HCPCS | HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. |
A5120 | Skin barrier, wipes or swabs, each | HCPCS | Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. |
K0011 | Stnd wt pwr whlchr w control | HCPCS | Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. |
Q4011 | Cast sup sht arm ped plaster | HCPCS | Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. |
A5120 | Skin barrier, wipes or swabs, each | HCPCS | HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book. |
K0011 | Stnd wt pwr whlchr w control | HCPCS | HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book. |
Q4011 | Cast sup sht arm ped plaster | HCPCS | HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book. |
73130 | XR HAND 3 VIEWS RT | HCPCS | Radiographs, including 3 views of the hand including the thumb and 2 views of the fingers of the right hand (with particular attention to the index and middle fingers) were ordered and done in the office. Imaging revealed no evidence of fractures in either the thumb, hand, or fingers. In this case, it would be appropriate to report 73130-LT (hand with thumb) and 73140-RT (fingers). Modifier 59 would not be required, as HCPCS modifier RT and modifier LT accomplish the same thing (identifying different anatomic sites). Additionally, the correct ICD-10-CM code for supporting medical necessity would need to be reported, which would include the symptoms the patient was feeling and the injury sustained. |
73140 | XR FINGERS 2 OR MORE RT | HCPCS | Radiographs, including 3 views of the hand including the thumb and 2 views of the fingers of the right hand (with particular attention to the index and middle fingers) were ordered and done in the office. Imaging revealed no evidence of fractures in either the thumb, hand, or fingers. In this case, it would be appropriate to report 73130-LT (hand with thumb) and 73140-RT (fingers). Modifier 59 would not be required, as HCPCS modifier RT and modifier LT accomplish the same thing (identifying different anatomic sites). Additionally, the correct ICD-10-CM code for supporting medical necessity would need to be reported, which would include the symptoms the patient was feeling and the injury sustained. |
73130 | XR HAND 3 VIEWS RT | HCPCS | Imaging revealed no evidence of fractures in either the thumb, hand, or fingers. In this case, it would be appropriate to report 73130-LT (hand with thumb) and 73140-RT (fingers). Modifier 59 would not be required, as HCPCS modifier RT and modifier LT accomplish the same thing (identifying different anatomic sites). Additionally, the correct ICD-10-CM code for supporting medical necessity would need to be reported, which would include the symptoms the patient was feeling and the injury sustained. Global or Split? |
73140 | XR FINGERS 2 OR MORE RT | HCPCS | Imaging revealed no evidence of fractures in either the thumb, hand, or fingers. In this case, it would be appropriate to report 73130-LT (hand with thumb) and 73140-RT (fingers). Modifier 59 would not be required, as HCPCS modifier RT and modifier LT accomplish the same thing (identifying different anatomic sites). Additionally, the correct ICD-10-CM code for supporting medical necessity would need to be reported, which would include the symptoms the patient was feeling and the injury sustained. Global or Split? |
73130 | XR HAND 3 VIEWS RT | HCPCS | In this case, it would be appropriate to report 73130-LT (hand with thumb) and 73140-RT (fingers). Modifier 59 would not be required, as HCPCS modifier RT and modifier LT accomplish the same thing (identifying different anatomic sites). Additionally, the correct ICD-10-CM code for supporting medical necessity would need to be reported, which would include the symptoms the patient was feeling and the injury sustained. Global or Split? Don't forget the global components of TC and 26 when coding for radiology services. |
73140 | XR FINGERS 2 OR MORE RT | HCPCS | In this case, it would be appropriate to report 73130-LT (hand with thumb) and 73140-RT (fingers). Modifier 59 would not be required, as HCPCS modifier RT and modifier LT accomplish the same thing (identifying different anatomic sites). Additionally, the correct ICD-10-CM code for supporting medical necessity would need to be reported, which would include the symptoms the patient was feeling and the injury sustained. Global or Split? Don't forget the global components of TC and 26 when coding for radiology services. |
74178 | HC CT ABD & PELVIS W/O AND W CONTRAST | HCPCS | Verify if the CT enterography was performed on the abdomen, pelvis, or both (abdomen/pelvis) and whether or not contrast was intravenously administered or not. The oral contrast is not a factor for code decision in this case. In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. |
74176 | HC CT ABDOMEN & PELVIS W/O CONTRAST | HCPCS | Verify if the CT enterography was performed on the abdomen, pelvis, or both (abdomen/pelvis) and whether or not contrast was intravenously administered or not. The oral contrast is not a factor for code decision in this case. In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. |
74177 | HC CT ABDOMEN & PELVIS W/CONTRAST | HCPCS | Verify if the CT enterography was performed on the abdomen, pelvis, or both (abdomen/pelvis) and whether or not contrast was intravenously administered or not. The oral contrast is not a factor for code decision in this case. In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. |
74178 | HC CT ABD & PELVIS W/O AND W CONTRAST | HCPCS | The oral contrast is not a factor for code decision in this case. In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. |
74176 | HC CT ABDOMEN & PELVIS W/O CONTRAST | HCPCS | The oral contrast is not a factor for code decision in this case. In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. |
74177 | HC CT ABDOMEN & PELVIS W/CONTRAST | HCPCS | The oral contrast is not a factor for code decision in this case. In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. |
74178 | HC CT ABD & PELVIS W/O AND W CONTRAST | HCPCS | In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. |
74176 | HC CT ABDOMEN & PELVIS W/O CONTRAST | HCPCS | In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. |
74177 | HC CT ABDOMEN & PELVIS W/CONTRAST | HCPCS | In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.References:
- John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
- Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
Nick Anderson, Interview with a CT technician
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. |
1744 | Endoscopic robotic assisted procedure | ICD | The number of off-road events per hour on the simulator was independently associated with a history of previous RTA (OR 1.004, 95% CI 1.0004 to 1.008, p<0.03). The Epworth score was independently
Spoerri, Adrian; Egger, Matthias; von Elm, Erik
Road traffic accidents (RTA) are an important cause of premature death. We examined socio-demographic and geographical determinants of RTA mortality in Switzerland by linking 2000 census data to RTA mortality records 2000-2005 (ICD-10 codes V00-V99). Data from 5.5 million residents aged 18-94 years, 1744 study areas, and 1620 RTA deaths were analyzed, including 978 deaths (60.4%) in motor vehicle occupants, 254 (15.7%) in motorcyclists, 107 (6.6%) in cyclists, and 259 (16.0%) in pedestrians. Weibull survival models and Bayesian methods were used to calculate hazard ratios (HR), and standardized mortality ratios (SMR) across study areas. |
1743 | Percutaneous robotic assisted procedure | ICD | 2010, 7, 1720–1743. [Google Scholar] [CrossRef]
- Good Health Adds Life to Years. Global Brief for World Health Day 2012; WHO: Geneva, Switzerland, 2012. - Giannangelo, K.; Millar, J. Mapping SNOMED CT to ICD-10. Stud. |
1999 | ANESTHESIOLOGY GROUP | CPT | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
S2120 | Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36511 | PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36513 | PR THERAPEUTIC APHERESIS PLATELETS | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36512 | PR THERAPEUTIC APHERESIS RED BLOOD CELLS | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36521 | USE 36516 | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36520 | SEE 36511-36512 | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
1999 | ANESTHESIOLOGY GROUP | CPT | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
S2120 | Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation | 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 HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
36511 | PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS | 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 HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
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