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88144 | Cytopath, c/v, thin lyr redo | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added
10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added; 88144, 88145 deleted; ICD-9 Procedure: "Microscopic examination of specimen from female genital tract" deleted; ICD-9 Diagnosis: 233.1 added; HCPCS: G0141, G0147, G0148 added; "with manual screening and computer-assisted rescreening by cytotechnologist under physician supervision," "Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and computer-assisted rescreening using cell selection and review under physician supervision" deleted
9/29/2006: Policy updated. Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. |
88175 | PAP | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added
10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added; 88144, 88145 deleted; ICD-9 Procedure: "Microscopic examination of specimen from female genital tract" deleted; ICD-9 Diagnosis: 233.1 added; HCPCS: G0141, G0147, G0148 added; "with manual screening and computer-assisted rescreening by cytotechnologist under physician supervision," "Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and computer-assisted rescreening using cell selection and review under physician supervision" deleted
9/29/2006: Policy updated. Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. |
87622 | Hpv dna quant | HCPCS | Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. |
P3000 | Screen pap by tech w md supv | HCPCS | Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. |
88174 | Cytopath c/v auto in fluid | HCPCS | Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. |
P3001 | Screening pap smear by phys | HCPCS | Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. |
88175 | PAP | HCPCS | Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. |
87622 | Hpv dna quant | HCPCS | CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. |
P3000 | Screen pap by tech w md supv | HCPCS | CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. |
88174 | Cytopath c/v auto in fluid | HCPCS | CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. |
P3001 | Screening pap smear by phys | HCPCS | CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. |
88175 | PAP | HCPCS | CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy
11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. |
87622 | Hpv dna quant | HCPCS | 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. |
G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician | HCPCS | 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. |
87622 | Hpv dna quant | HCPCS | 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. |
G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician | HCPCS | 7/22/2008: Policy reviewed, no changes
09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. |
87622 | Hpv dna quant | HCPCS | The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. Policy title changed from "Monolayer Slide Preparation and AutoSlide Reading Systems for Cervical Cancer Screening" to "Cervical Cancer Screening Technologies with Pap and HPV." |
G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician | HCPCS | The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. Policy title changed from "Monolayer Slide Preparation and AutoSlide Reading Systems for Cervical Cancer Screening" to "Cervical Cancer Screening Technologies with Pap and HPV." |
87622 | Hpv dna quant | HCPCS | CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. Policy title changed from "Monolayer Slide Preparation and AutoSlide Reading Systems for Cervical Cancer Screening" to "Cervical Cancer Screening Technologies with Pap and HPV." 05/01/2011: The policy statement regarding HPV testing in conjunction with Pap smears was revised to state that HPV testing may be considered medically necessary only if there is an abnormal Pap smear documented in the medical record. |
G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician | HCPCS | CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. Policy title changed from "Monolayer Slide Preparation and AutoSlide Reading Systems for Cervical Cancer Screening" to "Cervical Cancer Screening Technologies with Pap and HPV." 05/01/2011: The policy statement regarding HPV testing in conjunction with Pap smears was revised to state that HPV testing may be considered medically necessary only if there is an abnormal Pap smear documented in the medical record. |
32856 | Prepare donor lung double | HCPCS | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. |
S2061 | Donor lobectomy (lung) for transplantation, living donor | HCPCS | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. |
32855 | Prepare donor lung single | HCPCS | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. |
S2060 | LOBAR LUNG TRANSPLANTATION | HCPCS | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. |
32856 | Prepare donor lung double | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. |
S2061 | Donor lobectomy (lung) for transplantation, living donor | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. |
32855 | Prepare donor lung single | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. |
S2060 | LOBAR LUNG TRANSPLANTATION | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 procedure code range 33.50-33.52 listed separately, ICD-9 diagnosis code range 011.0-011.2, 011.4, 011.9, 277.00-277.01, 402.00-402.91, 415.11-415.19, 416.0, 416.8, 416.9, 491.20-491.21, 500-505 listed separately
6/23/2004: Policy reviewed, Sources updated, Policy exception added
07/21/2005: Policy reviewed by MPAC, "HIV positivity is not an absolute contraindication to transplant. Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. |
32856 | Prepare donor lung double | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. CPT4 2006 revisions added to policy. 9/20/2007: Code Reference section updated. |
S2061 | Donor lobectomy (lung) for transplantation, living donor | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. CPT4 2006 revisions added to policy. 9/20/2007: Code Reference section updated. |
32855 | Prepare donor lung single | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. CPT4 2006 revisions added to policy. 9/20/2007: Code Reference section updated. |
S2060 | LOBAR LUNG TRANSPLANTATION | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. CPT4 2006 revisions added to policy. 9/20/2007: Code Reference section updated. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 2006 revisions added to policy. 3/23/2006: Coding updated. CPT4 2006 revisions added to policy. 9/20/2007: Code Reference section updated. |
0369 | Operating Room Services - Other or Services | RC | Introduction to ICD-10-PCS Procedure Coding 27. Medical and Surgical Procedures (Section 0) 28. Medical and Surgical Related Procedures (Sections 1-9) 29. Ancillary Procedures (Sections B-D, F-H) SECTION IV: PUTTING IT ALL TOGETHER 30. Putting it All Together APPENDIX A: EXERCISE ANSWERS APPENDIX B: GLOSSARY APPENDIX C: INDEX
Number Of Pages:
- ID: 9780132860369
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- 1st Class Delivery: Yes
- Courier Delivery: Yes
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Prices are for internet purchases only. |
0132 | Room & Board - Semi-private - Three and Four Beds - Obstetrics (OB) | RC | Introduction to ICD-10-PCS Procedure Coding 27. Medical and Surgical Procedures (Section 0) 28. Medical and Surgical Related Procedures (Sections 1-9) 29. Ancillary Procedures (Sections B-D, F-H) SECTION IV: PUTTING IT ALL TOGETHER 30. Putting it All Together APPENDIX A: EXERCISE ANSWERS APPENDIX B: GLOSSARY APPENDIX C: INDEX
Number Of Pages:
- ID: 9780132860369
- Saver Delivery: Yes
- 1st Class Delivery: Yes
- Courier Delivery: Yes
- Store Delivery: Yes
Prices are for internet purchases only. |
0369 | Operating Room Services - Other or Services | RC | Medical and Surgical Procedures (Section 0) 28. Medical and Surgical Related Procedures (Sections 1-9) 29. Ancillary Procedures (Sections B-D, F-H) SECTION IV: PUTTING IT ALL TOGETHER 30. Putting it All Together APPENDIX A: EXERCISE ANSWERS APPENDIX B: GLOSSARY APPENDIX C: INDEX
Number Of Pages:
- ID: 9780132860369
- Saver Delivery: Yes
- 1st Class Delivery: Yes
- Courier Delivery: Yes
- Store Delivery: Yes
Prices are for internet purchases only. Prices and availability in WHSmith Stores may vary significantly
© Copyright 2013 - 2016 WHSmith and its suppliers. |
0132 | Room & Board - Semi-private - Three and Four Beds - Obstetrics (OB) | RC | Medical and Surgical Procedures (Section 0) 28. Medical and Surgical Related Procedures (Sections 1-9) 29. Ancillary Procedures (Sections B-D, F-H) SECTION IV: PUTTING IT ALL TOGETHER 30. Putting it All Together APPENDIX A: EXERCISE ANSWERS APPENDIX B: GLOSSARY APPENDIX C: INDEX
Number Of Pages:
- ID: 9780132860369
- Saver Delivery: Yes
- 1st Class Delivery: Yes
- Courier Delivery: Yes
- Store Delivery: Yes
Prices are for internet purchases only. Prices and availability in WHSmith Stores may vary significantly
© Copyright 2013 - 2016 WHSmith and its suppliers. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | For this procedure, we’d code 35471 for “transluminal balloon angioplasty, percutaneous; renal or other visceral artery,” and we’d add the modifier -66 for “surgical team.” So we’d end up with 35471-66. Physical Status Modifier (for Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. Note that there may be some overlap or contradiction with the set of HCPCS modifiers, which we’ll cover in more depth later on. |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | For a patient with a respiratory infection, NOS, code J98.8, Other specified respiratory disorders, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere. Patients that develop acute respiratory distress (ARDS) would be coded with J80, Acute respiratory distress syndrome and B97.29 Other coronavirus as the cause of diseases classified elsewhere. The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | For a patient with a respiratory infection, NOS, code J98.8, Other specified respiratory disorders, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere. Patients that develop acute respiratory distress (ARDS) would be coded with J80, Acute respiratory distress syndrome and B97.29 Other coronavirus as the cause of diseases classified elsewhere. The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
87635 | SARS-COV-2 COVID-19 AMP PRB | HCPCS | For a patient with a respiratory infection, NOS, code J98.8, Other specified respiratory disorders, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere. Patients that develop acute respiratory distress (ARDS) would be coded with J80, Acute respiratory distress syndrome and B97.29 Other coronavirus as the cause of diseases classified elsewhere. The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | Patients that develop acute respiratory distress (ARDS) would be coded with J80, Acute respiratory distress syndrome and B97.29 Other coronavirus as the cause of diseases classified elsewhere. The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | Patients that develop acute respiratory distress (ARDS) would be coded with J80, Acute respiratory distress syndrome and B97.29 Other coronavirus as the cause of diseases classified elsewhere. The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
87635 | SARS-COV-2 COVID-19 AMP PRB | HCPCS | Patients that develop acute respiratory distress (ARDS) would be coded with J80, Acute respiratory distress syndrome and B97.29 Other coronavirus as the cause of diseases classified elsewhere. The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
87635 | SARS-COV-2 COVID-19 AMP PRB | HCPCS | The AMA and CMS have added new codes to report the COVID-19 testing. These would be used in conjunction with the ICD-10-CM codes listed above. The CPT code added by the AMA is a Category I CPT code and is listed as follows:
87635 – Infectious agent detection by nucleic acid (DNA or RNA); sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus [COVID-19], amplified probe technique
HCPCS codes for Medicare Patients are as follows:
U0001 – Providers billing for the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel
U0002 – Laboratories and healthcare facilities Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel |
S8930 | Auricular electrostimulation | HCPCS | Cranial electrotherapy stimulation (also known as cranial electrostimulation therapy or CES) is investigational. Electrical stimulation of auricular acupuncture points is investigational. There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. |
97813 | PR ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN | HCPCS | Cranial electrotherapy stimulation (also known as cranial electrostimulation therapy or CES) is investigational. Electrical stimulation of auricular acupuncture points is investigational. There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. |
97814 | PR ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ | HCPCS | Cranial electrotherapy stimulation (also known as cranial electrostimulation therapy or CES) is investigational. Electrical stimulation of auricular acupuncture points is investigational. There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. |
S8930 | Auricular electrostimulation | HCPCS | Electrical stimulation of auricular acupuncture points is investigational. There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. There is no specific code for cranial electrotherapy stimulation. |
97813 | PR ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN | HCPCS | Electrical stimulation of auricular acupuncture points is investigational. There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. There is no specific code for cranial electrotherapy stimulation. |
97814 | PR ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ | HCPCS | Electrical stimulation of auricular acupuncture points is investigational. There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. There is no specific code for cranial electrotherapy stimulation. |
S8930 | Auricular electrostimulation | HCPCS | There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. There is no specific code for cranial electrotherapy stimulation. An unlisted code would likely be used. |
97813 | PR ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN | HCPCS | There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. There is no specific code for cranial electrotherapy stimulation. An unlisted code would likely be used. |
97814 | PR ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ | HCPCS | There are no CPT codes that are specific to electrical stimulation of auricular acupuncture points. The following CPT codes would probably be used:
97813: Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814: ; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure). The following specific HCPCS code for auricular stimulation became effective April 1, 2012:
S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient. There is no specific code for cranial electrotherapy stimulation. An unlisted code would likely be used. |
S8930 | Auricular electrostimulation | HCPCS | Adjuvant auricular electroacupuncture and autogenic training in rheumatoid arthritis: a randomized controlled trial. Auricular acupuncture and autogenic training in rheumatoid arthritis. Forsch Komplementmed 2008; 15(4):187-93. |CPT||See Policy Guidelines|
|ICD-9-CM Diagnosis||Investigational for all diagnoses|
|HCPCS||S8930||Electrical stimulation of auricular accupuncture points; each 15 minutes of personal one-on-one contact with the patient|
|ICD-10-CM (effective 10/1/14)||Investigational for all diagnoses|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this therapy.|
|8E0H300, 8E0H30Z||Other procedures, integumentary system, percutaneous, acupuncture code list|
Electrical stimulation therapy, cranial
Electrotherapy stimulation, cranial
|09/01/11||Add to Therapy section||Policy created with literature search through April 2011; clinical input reviewed; considered investigational|
|9/13/12||Replace policy||Policy updated with literature review through June 2012, references 1-7 added; cranial electrotherapy stimulation (CES) added as investigational. |
S8930 | Auricular electrostimulation | HCPCS | Auricular acupuncture and autogenic training in rheumatoid arthritis. Forsch Komplementmed 2008; 15(4):187-93. |CPT||See Policy Guidelines|
|ICD-9-CM Diagnosis||Investigational for all diagnoses|
|HCPCS||S8930||Electrical stimulation of auricular accupuncture points; each 15 minutes of personal one-on-one contact with the patient|
|ICD-10-CM (effective 10/1/14)||Investigational for all diagnoses|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this therapy.|
|8E0H300, 8E0H30Z||Other procedures, integumentary system, percutaneous, acupuncture code list|
Electrical stimulation therapy, cranial
Electrotherapy stimulation, cranial
|09/01/11||Add to Therapy section||Policy created with literature search through April 2011; clinical input reviewed; considered investigational|
|9/13/12||Replace policy||Policy updated with literature review through June 2012, references 1-7 added; cranial electrotherapy stimulation (CES) added as investigational. “Cranial Electrotherapy Stimulation (CES)” added to policy title.|
|8/08/13||Replace policy||Policy updated with literature review through July 10, 2013; policy statement unchanged| |
S8930 | Auricular electrostimulation | HCPCS | Forsch Komplementmed 2008; 15(4):187-93. |CPT||See Policy Guidelines|
|ICD-9-CM Diagnosis||Investigational for all diagnoses|
|HCPCS||S8930||Electrical stimulation of auricular accupuncture points; each 15 minutes of personal one-on-one contact with the patient|
|ICD-10-CM (effective 10/1/14)||Investigational for all diagnoses|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this therapy.|
|8E0H300, 8E0H30Z||Other procedures, integumentary system, percutaneous, acupuncture code list|
Electrical stimulation therapy, cranial
Electrotherapy stimulation, cranial
|09/01/11||Add to Therapy section||Policy created with literature search through April 2011; clinical input reviewed; considered investigational|
|9/13/12||Replace policy||Policy updated with literature review through June 2012, references 1-7 added; cranial electrotherapy stimulation (CES) added as investigational. “Cranial Electrotherapy Stimulation (CES)” added to policy title.|
|8/08/13||Replace policy||Policy updated with literature review through July 10, 2013; policy statement unchanged| |
S8930 | Auricular electrostimulation | HCPCS | |CPT||See Policy Guidelines|
|ICD-9-CM Diagnosis||Investigational for all diagnoses|
|HCPCS||S8930||Electrical stimulation of auricular accupuncture points; each 15 minutes of personal one-on-one contact with the patient|
|ICD-10-CM (effective 10/1/14)||Investigational for all diagnoses|
|ICD-10-PCS (effective 10/1/14)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this therapy.|
|8E0H300, 8E0H30Z||Other procedures, integumentary system, percutaneous, acupuncture code list|
Electrical stimulation therapy, cranial
Electrotherapy stimulation, cranial
|09/01/11||Add to Therapy section||Policy created with literature search through April 2011; clinical input reviewed; considered investigational|
|9/13/12||Replace policy||Policy updated with literature review through June 2012, references 1-7 added; cranial electrotherapy stimulation (CES) added as investigational. “Cranial Electrotherapy Stimulation (CES)” added to policy title.|
|8/08/13||Replace policy||Policy updated with literature review through July 10, 2013; policy statement unchanged| |
76499 | XR UNLISTED DIAGNOSTIC PROCEDU | HCPCS | POLICY HISTORY6/16/2008: Policy added
7/17/2008: Reviewed and approved by the Medical Policy Advisory Committee (MPAC)
12/31/2008: Code reference section updated per 2009 CPT/HCPCS revisions
6/23/2010: Policy statement unchanged. FEP verbiage added to Policy Exceptions section. CPT Code 0028T was removed because the code was deleted 12/31/2008. CPT Code 76499 was added to the Non-Covered Codes Table. 04/20/2011: Policy reviewed; no changes. |
87635 | SARS-COV-2 COVID-19 AMP PRB | HCPCS | For instance, the first new code — 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique — was published and effective March 13, 2020. The vaccine and immunization codes may include a note indicating they are effective once the vaccine receives Emergency Use Authorization or approval from the Food and Drug Administration. The AMA posts new codes on its COVID-19 Coding and Guidance page and its COVID-19 CPT® Vaccine and Immunizations Codes page. The pages also include links to CPT® Assistant guides for many of the codes. HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | The AMA posts new codes on its COVID-19 Coding and Guidance page and its COVID-19 CPT® Vaccine and Immunizations Codes page. The pages also include links to CPT® Assistant guides for many of the codes. HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | The AMA posts new codes on its COVID-19 Coding and Guidance page and its COVID-19 CPT® Vaccine and Immunizations Codes page. The pages also include links to CPT® Assistant guides for many of the codes. HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. Dates of service for these codes can go back to Feb. 4, 2020. Healthcare organizations also need to watch for changes to medical coding modifiers. |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. Dates of service for these codes can go back to Feb. 4, 2020. Healthcare organizations also need to watch for changes to medical coding modifiers. |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. Dates of service for these codes can go back to Feb. 4, 2020. Healthcare organizations also need to watch for changes to medical coding modifiers. A case in point is modifier CS Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency. |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. Dates of service for these codes can go back to Feb. 4, 2020. Healthcare organizations also need to watch for changes to medical coding modifiers. A case in point is modifier CS Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | CPT identifies the services provided and helps determine how much physicians will be paid for their services by insurance companies. HCPCS – Healthcare Common Procedure Coding System (HCPCS) is a set of health care procedure codes based on the AMA’s CPT system. HCPCS is a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). The HCPCS coding system was created to standardize the coding of specific items and services provided by health care professionals and billed to Medicare and Medicaid. The HIPPA Act of 1996 made the use of HCPCS coding mandatory for processing insurance claims through Medicare and Medicaid. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | HCPCS – Healthcare Common Procedure Coding System (HCPCS) is a set of health care procedure codes based on the AMA’s CPT system. HCPCS is a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). The HCPCS coding system was created to standardize the coding of specific items and services provided by health care professionals and billed to Medicare and Medicaid. The HIPPA Act of 1996 made the use of HCPCS coding mandatory for processing insurance claims through Medicare and Medicaid. The Six C’s of Medical Records
Medical office administrative assistants should memorize these six C’s to maintain accurate patient medical records. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | HCPCS is a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). The HCPCS coding system was created to standardize the coding of specific items and services provided by health care professionals and billed to Medicare and Medicaid. The HIPPA Act of 1996 made the use of HCPCS coding mandatory for processing insurance claims through Medicare and Medicaid. The Six C’s of Medical Records
Medical office administrative assistants should memorize these six C’s to maintain accurate patient medical records. They are client’s words, clarity, completeness, conciseness, chronological order, and confidentiality. |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | Consistent with this WHO update to the ICD-10, the CDC will implement U07.1 2019-nCoV acute respiratory disease into ICD-10-CM for reporting, effective with the next update, Oct. 1, 2020. See the announcement and interim coding guidance for more information. Does COVID-19 Have a Test Code? According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2. CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | Consistent with this WHO update to the ICD-10, the CDC will implement U07.1 2019-nCoV acute respiratory disease into ICD-10-CM for reporting, effective with the next update, Oct. 1, 2020. See the announcement and interim coding guidance for more information. Does COVID-19 Have a Test Code? According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2. CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | See the announcement and interim coding guidance for more information. Does COVID-19 Have a Test Code? According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2. CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories in accordance with a new policy the Food and Drug Administration issued Feb. 29. |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | See the announcement and interim coding guidance for more information. Does COVID-19 Have a Test Code? According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2. CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories in accordance with a new policy the Food and Drug Administration issued Feb. 29. |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | Does COVID-19 Have a Test Code? According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2. CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories in accordance with a new policy the Food and Drug Administration issued Feb. 29. Medicare claims will be accepted beginning on April 1, 2020, for tests billed with these codes from Feb. 4, 2020, onward. |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | Does COVID-19 Have a Test Code? According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2. CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories in accordance with a new policy the Food and Drug Administration issued Feb. 29. Medicare claims will be accepted beginning on April 1, 2020, for tests billed with these codes from Feb. 4, 2020, onward. |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2. CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories in accordance with a new policy the Food and Drug Administration issued Feb. 29. Medicare claims will be accepted beginning on April 1, 2020, for tests billed with these codes from Feb. 4, 2020, onward. Local Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for these newly created codes until CMS established national payment rates. |
U0001 | HC NOVEL CORONAVIRUS REALT TIME PCR | HCPCS | According to a Centers for Medicare & Medicaid Services (CMS) press release, “Healthcare providers who need to test patients for Coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).” This code is used specifically for CDC testing labs to test patients for SARS-CoV-2. CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories in accordance with a new policy the Food and Drug Administration issued Feb. 29. Medicare claims will be accepted beginning on April 1, 2020, for tests billed with these codes from Feb. 4, 2020, onward. Local Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for these newly created codes until CMS established national payment rates. |
U0002 | HC Sars-Cov-2 Naa Coronavirus | HCPCS | CMS has developed a second HCPCS Level II code (U0002) for labs to bill for non-CDC lab tests for SARS-CoV-2/2019-nCoV (COVD-19). This code may be used for tests developed by certain laboratories in accordance with a new policy the Food and Drug Administration issued Feb. 29. Medicare claims will be accepted beginning on April 1, 2020, for tests billed with these codes from Feb. 4, 2020, onward. Local Medicare Administrative Contractors are responsible for developing the payment amount for claims they receive for these newly created codes until CMS established national payment rates. What Should Your Facility Do to Prepare for a Local Outbreak? |
E2120 | Pulse gen sys tx endolymp fl | HCPCS | Patients then place an ear-cuff in the external ear canal and treat themselves for 3 minutes, 3 times daily. Treatment is continued for as long as patients find themselves in a period of attacks of vertigo. In 1999, the Meniett® device (Medtronic, Minneapolis, MN) received clearance to market through a U.S. Food and Drug Administration (FDA) 510(k) process specifically as a symptomatic treatment of Meniere's disease. Transtympanic micropressure applications as a treatment of Meniere`s disease are considered investigational. HCPCS code E2120, pulse generator system for tympanic treatment of inner ear endolymphatic fluid, describes the Meniett device. |
E2120 | Pulse gen sys tx endolymp fl | HCPCS | In 1999, the Meniett® device (Medtronic, Minneapolis, MN) received clearance to market through a U.S. Food and Drug Administration (FDA) 510(k) process specifically as a symptomatic treatment of Meniere's disease. Transtympanic micropressure applications as a treatment of Meniere`s disease are considered investigational. HCPCS code E2120, pulse generator system for tympanic treatment of inner ear endolymphatic fluid, describes the Meniett device. Use of the Meniett device requires a prior tympanostomy procedure, a novel indication for this common procedure. Plans with specific medical necessity criteria for tympanostomy may thus be able to prospectively identify claims for the Meniett device. |
A4638 | Repl batt pulse gen sys | HCPCS | 2012. Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. |
E2120 | Pulse gen sys tx endolymp fl | HCPCS | 2012. Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. |
A4638 | Repl batt pulse gen sys | HCPCS | Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged| |
E2120 | Pulse gen sys tx endolymp fl | HCPCS | Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged| |
A4638 | Repl batt pulse gen sys | HCPCS | Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged| |
E2120 | Pulse gen sys tx endolymp fl | HCPCS | Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged| |
A4638 | Repl batt pulse gen sys | HCPCS | |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged| |
E2120 | Pulse gen sys tx endolymp fl | HCPCS | |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged| |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | With this adoption, CMS mandated the use of HCPCS to report services for Part B of the Medicare Program. In October 1986, CMS also required state Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS mandated the use of CPT for reporting outpatient hospital surgical procedures. Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services. HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | In October 1986, CMS also required state Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS mandated the use of CPT for reporting outpatient hospital surgical procedures. Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services. HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. This includes transactions and code sets, national provider identifier, national employer identifier, security and privacy. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. This includes transactions and code sets, national provider identifier, national employer identifier, security and privacy. The Final Rule for transactions and code sets was issued on Aug. 17, 2000. The rule names CPT (including codes and modifiers) and HCPCS as the procedure code set for:
- Physician services
- Physical and occupational therapy services
- Radiological procedures
- Clinical laboratory tests
- Other medical diagnostic procedures
- Hearing and vision services
- Transportation services including ambulance
The Final Rule also named ICD-10 volumes 1 and 2 as the code set for diagnosis codes, ICD-10-CM volume 3 for inpatient hospital services, CDT for dental services and NDC codes for drugs. All health care plans and providers who transmit information electronically were required to use established national standards by the end of the implementation period, Oct. 16, 2003. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | For the procedure, we’d code 23140 for “excision or curretage of bone cyst or benign tumor, humerus; with autograft (includes obtaining the graft).” Since the procedure was completed but not fully successful, we’d add the -52 modifier, for reduced services, to the code, and we’d end up with 23140-52. Physical Status Modifier (for Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. Note that there may be some overlap or contradiction with the set of HCPCS modifiers, which we’ll cover in more depth later on. |
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