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86003 | YELLOW JACKET IGE | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70496 | HC CTA, HEAD, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST I | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
83013 | H PYLORI (C-13) BREATH | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70552 | MRI scan of brain with contrast | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
78607 | Brain imaging (3d) | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70450 | HC CT HEAD/BRAIN WITHOUT DYE | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
84520 | UREA NITROGEN_ QUANTITATIVE | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70470 | HC CT HEAD/BRAIN W&WO DYE | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
84443 | TTH TSH-SP | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
31235 | PR NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85651 | SEDIMENTATION RATE, ERYTHROCYTE_ NON-AUTOMATED | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
78268 | HC NM UREA TEST C14 ANALYSIS | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85652 | SED RATE | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85014 | Red blood cell concentration measurement | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
31237 | PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70553 | MRI scan of brain before and after contrast | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
95819 | PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85032 | Manual blood cell count | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
78267 | HC NM UREA TEST C14 ACQ | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
80150 | HC AMIKACIN LEVEL TROUGH | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
95816 | PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
95012 | Test to measure the level of nitric oxide gas | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
92511 | PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70460 | HC CT HEAD/BRAIN WITH DYE | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
80202 | VANCO (TROUGH) | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
78608 | HC BRAIN (CNS) TUMOR LOCALIZATION | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
87338 | INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE (EG, ENZYME IMMUNOASSAY [EIA], ENZYME-LINKED IMMUNOSORBENT ASSAY [ELISA], FLUORESCENCE IMMUNOASSAY [FIA], IMMUNOCHEMILUMINOMETRIC ASSAY [IMCA]), QUALITATIVE OR SEMIQUANTITATIVE_ HELICOBACTER PYLORI, STOOL | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
31233 | PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
92512 | PR NASAL FUNCTION STUDIES | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70551 | MRI scan of brain without contrast | HCPCS | Nasal NO production appeared to decrease with age and also seemed to be associated to overall olfactory function and in particular to central nervous system tasks such as olfactory discrimination and identification but not to olfactory thresholds. The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85048 | WHITE CELL COUNT (WBC) | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
31231 | PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
82947 | HC GLUCOSE; QUANTITATIVE, WHOLE BLOOD | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
86003 | YELLOW JACKET IGE | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70496 | HC CTA, HEAD, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST I | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
83013 | H PYLORI (C-13) BREATH | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70552 | MRI scan of brain with contrast | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
78607 | Brain imaging (3d) | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70450 | HC CT HEAD/BRAIN WITHOUT DYE | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
84520 | UREA NITROGEN_ QUANTITATIVE | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70470 | HC CT HEAD/BRAIN W&WO DYE | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
84443 | TTH TSH-SP | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
31235 | PR NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85651 | SEDIMENTATION RATE, ERYTHROCYTE_ NON-AUTOMATED | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
78268 | HC NM UREA TEST C14 ANALYSIS | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85652 | SED RATE | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85014 | Red blood cell concentration measurement | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
31237 | PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70553 | MRI scan of brain before and after contrast | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
95819 | PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
85032 | Manual blood cell count | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
78267 | HC NM UREA TEST C14 ACQ | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
80150 | HC AMIKACIN LEVEL TROUGH | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
95816 | PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
95012 | Test to measure the level of nitric oxide gas | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
92511 | PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70460 | HC CT HEAD/BRAIN WITH DYE | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
80202 | VANCO (TROUGH) | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
78608 | HC BRAIN (CNS) TUMOR LOCALIZATION | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
87338 | INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE (EG, ENZYME IMMUNOASSAY [EIA], ENZYME-LINKED IMMUNOSORBENT ASSAY [ELISA], FLUORESCENCE IMMUNOASSAY [FIA], IMMUNOCHEMILUMINOMETRIC ASSAY [IMCA]), QUALITATIVE OR SEMIQUANTITATIVE_ HELICOBACTER PYLORI, STOOL | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
31233 | PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
92512 | PR NASAL FUNCTION STUDIES | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
70551 | MRI scan of brain without contrast | HCPCS | The authors stated that these findings raised questions about the link and interaction between olfactory function and nNO. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|31231||Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)|
|70450||Computed tomography head or brain; without contrast material|
|70460||with contrast material(s)|
|70470||without contrast material, followed by contrast material(s) and further sections|
|70496||Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing|
|70551||Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material|
|70552||with contrast material(s)|
|70553||without contrast material, followed by contrast material(s) and further sequences|
|82947||Glucose; quantitative, blood (except reagent strip)|
|84443||Thyroid stimulating hormone (TSH)|
|84520||Urea nitrogen; quantitative|
|85014||Blood count; hematocrit (Hct)|
|85032||manual cell count (erythrocyte, leukocyte, or platelet) each|
|85048||leukocyte (WBC), automated|
|85651 - 85652||Sedimentation rate, erythrocyte|
|86003||Allergen specific IgE; quantitative or semiquantitative, each allergen|
|CPT codes not covered for indications listed in the CPB:|
|78267||Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori]|
|78268||analysis [Helicobacter pylori]|
|78607||Brain imaging, tomographic (SPECT)|
|78608||Brain imaging, positron emission tomography (PET); metabolic evaluation|
|83013||Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13)|
|87338||Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool|
|92512||Nasal function studies (e.g., rhinomanometry)|
|95012||Nitric oxide expired gas determination|
|Other CPT codes related to the CPB:|
|31233||Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)|
|31235||Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium)|
|31237||Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)|
|80150 - 80202||Therapeutic drug assays|
|92511||Nasopharyngoscopy with endoscope (separate procedure)|
|95816 - 95819||Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep|
|ICD-10 codes covered if selection criteria are met:|
|R43.0 - R43.9||Disturbances of smell and taste| |
90739 | HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY | HCPCS | The infection can last as little as a few weeks or become a lifelong, debilitating illness. There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. |
90746 | Hepb vaccine 3 dose adult im | HCPCS | The infection can last as little as a few weeks or become a lifelong, debilitating illness. There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. |
90743 | HC HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM | HCPCS | The infection can last as little as a few weeks or become a lifelong, debilitating illness. There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. |
G0010 | PR ADMIN HEPATITIS B VACCINE | HCPCS | The infection can last as little as a few weeks or become a lifelong, debilitating illness. There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. |
90744 | Hepb vacc 3 dose ped/adol im | HCPCS | The infection can last as little as a few weeks or become a lifelong, debilitating illness. There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. |
90747 | HC HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM | HCPCS | The infection can last as little as a few weeks or become a lifelong, debilitating illness. There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. |
90740 | Hepb vacc 3 dose immunsup im | HCPCS | The infection can last as little as a few weeks or become a lifelong, debilitating illness. There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. |
90739 | HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY | HCPCS | There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. For conditions of coverage, refer to Medicare National Coverage Determinations Manual Chapter 1, Part 4, section 210.10 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs. |
90746 | Hepb vaccine 3 dose adult im | HCPCS | There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. For conditions of coverage, refer to Medicare National Coverage Determinations Manual Chapter 1, Part 4, section 210.10 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs. |
90743 | HC HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM | HCPCS | There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. For conditions of coverage, refer to Medicare National Coverage Determinations Manual Chapter 1, Part 4, section 210.10 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs. |
G0010 | PR ADMIN HEPATITIS B VACCINE | HCPCS | There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. For conditions of coverage, refer to Medicare National Coverage Determinations Manual Chapter 1, Part 4, section 210.10 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs. |
90744 | Hepb vacc 3 dose ped/adol im | HCPCS | There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. For conditions of coverage, refer to Medicare National Coverage Determinations Manual Chapter 1, Part 4, section 210.10 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs. |
90747 | HC HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM | HCPCS | There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. For conditions of coverage, refer to Medicare National Coverage Determinations Manual Chapter 1, Part 4, section 210.10 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs. |
90740 | Hepb vacc 3 dose immunsup im | HCPCS | There is no vaccine for Hepatitis C.
Coding and Billing Guidelines
Medicare Part B provides payment for Hepatitis B vaccine and its administration, as well as for screening for sexually transmitted infections (STIs) and Hepatitis C, and high-intensity behavioral counseling to prevent STIs. CPT® vaccination codes:
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
When billing Medicare Part B, vaccine administration code is HCPCS Level II G0010 Administration of hepatitis b vaccine. Be sure to link diagnosis code ICD-9-CM V05.3 Need for prophylactic vaccination and inoculation against viral hepatitis (ICD-10 Z23 Encounter for immunization) to the procedure code. Because Hepatitis vaccine is a preventive service, eligible beneficiaries may receive these services with no out-of-pocket costs. For conditions of coverage, refer to Medicare National Coverage Determinations Manual Chapter 1, Part 4, section 210.10 – Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs. |
G6015 | Radiation tx delivery imrt | HCPCS | IMRT remains investigational for all other uses in the abdomen and pelvis. Policy guidelines updated regarding radiation tolerance doses for normal tissues of the abdomen and pelvis. 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. |
77386 | HC IMRT COMPLEX | HCPCS | IMRT remains investigational for all other uses in the abdomen and pelvis. Policy guidelines updated regarding radiation tolerance doses for normal tissues of the abdomen and pelvis. 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. |
77385 | HC IMRT SIMPLE | HCPCS | IMRT remains investigational for all other uses in the abdomen and pelvis. Policy guidelines updated regarding radiation tolerance doses for normal tissues of the abdomen and pelvis. 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | IMRT remains investigational for all other uses in the abdomen and pelvis. Policy guidelines updated regarding radiation tolerance doses for normal tissues of the abdomen and pelvis. 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. |
G6015 | Radiation tx delivery imrt | HCPCS | Policy guidelines updated regarding radiation tolerance doses for normal tissues of the abdomen and pelvis. 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. |
77386 | HC IMRT COMPLEX | HCPCS | Policy guidelines updated regarding radiation tolerance doses for normal tissues of the abdomen and pelvis. 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. |
77385 | HC IMRT SIMPLE | HCPCS | Policy guidelines updated regarding radiation tolerance doses for normal tissues of the abdomen and pelvis. 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Policy guidelines updated regarding radiation tolerance doses for normal tissues of the abdomen and pelvis. 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. |
G6015 | Radiation tx delivery imrt | HCPCS | 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. Policy statements updated to change "radiation therapy" to "radiotherapy." |
77386 | HC IMRT COMPLEX | HCPCS | 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. Policy statements updated to change "radiation therapy" to "radiotherapy." |
77385 | HC IMRT SIMPLE | HCPCS | 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. Policy statements updated to change "radiation therapy" to "radiotherapy." |
G6016 | PR DELIVERY COMP IMRT | HCPCS | 03/13/2014: Policy reviewed; no changes. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. Policy statements updated to change "radiation therapy" to "radiotherapy." |
G6015 | Radiation tx delivery imrt | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. Policy statements updated to change "radiation therapy" to "radiotherapy." Removed "squamous cell" from the first medically necessary policy statement. |
77386 | HC IMRT COMPLEX | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. Policy statements updated to change "radiation therapy" to "radiotherapy." Removed "squamous cell" from the first medically necessary policy statement. |
77385 | HC IMRT SIMPLE | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. Policy statements updated to change "radiation therapy" to "radiotherapy." Removed "squamous cell" from the first medically necessary policy statement. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following HCPCS codes to the Code Reference section: G6015, G6016. 01/27/2015: Policy description updated regarding radiation techniques. Policy statements updated to change "radiation therapy" to "radiotherapy." Removed "squamous cell" from the first medically necessary policy statement. |
G0358 | IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.27 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; Covered table - CPT-4 code 38230 added; ICD-9 Procedure 41.01, 41.09 added; HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added, J9000-J9999 deleted; Non-Covered table - CPT-4 code 38204, 86812, 86813, 86816, 86817, 86821, 86822 added, ICD-9 Procedure 41.02, 41.03 added
3/22/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
1/3/2007: Policy reviewed, all medically necessary language removed as newer studies have shown no increase survival of patients with stem cell transplants after high-dose chemotherapy
1/4/2007: Code reference section updated; All CPT, HCPCS, and ICD-9 procedure codes moved to non-covered. Covered codes removed
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
86816 | HC HLA TYPING DR/DQ SINGLE AG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.27 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; Covered table - CPT-4 code 38230 added; ICD-9 Procedure 41.01, 41.09 added; HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added, J9000-J9999 deleted; Non-Covered table - CPT-4 code 38204, 86812, 86813, 86816, 86817, 86821, 86822 added, ICD-9 Procedure 41.02, 41.03 added
3/22/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
1/3/2007: Policy reviewed, all medically necessary language removed as newer studies have shown no increase survival of patients with stem cell transplants after high-dose chemotherapy
1/4/2007: Code reference section updated; All CPT, HCPCS, and ICD-9 procedure codes moved to non-covered. Covered codes removed
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0360 | Each additional hr 1-8 hrs | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.27 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; Covered table - CPT-4 code 38230 added; ICD-9 Procedure 41.01, 41.09 added; HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added, J9000-J9999 deleted; Non-Covered table - CPT-4 code 38204, 86812, 86813, 86816, 86817, 86821, 86822 added, ICD-9 Procedure 41.02, 41.03 added
3/22/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
1/3/2007: Policy reviewed, all medically necessary language removed as newer studies have shown no increase survival of patients with stem cell transplants after high-dose chemotherapy
1/4/2007: Code reference section updated; All CPT, HCPCS, and ICD-9 procedure codes moved to non-covered. Covered codes removed
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.27 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; Covered table - CPT-4 code 38230 added; ICD-9 Procedure 41.01, 41.09 added; HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added, J9000-J9999 deleted; Non-Covered table - CPT-4 code 38204, 86812, 86813, 86816, 86817, 86821, 86822 added, ICD-9 Procedure 41.02, 41.03 added
3/22/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
1/3/2007: Policy reviewed, all medically necessary language removed as newer studies have shown no increase survival of patients with stem cell transplants after high-dose chemotherapy
1/4/2007: Code reference section updated; All CPT, HCPCS, and ICD-9 procedure codes moved to non-covered. Covered codes removed
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
86821 | Lymphocyte culture mixed | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.27 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; Covered table - CPT-4 code 38230 added; ICD-9 Procedure 41.01, 41.09 added; HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added, J9000-J9999 deleted; Non-Covered table - CPT-4 code 38204, 86812, 86813, 86816, 86817, 86821, 86822 added, ICD-9 Procedure 41.02, 41.03 added
3/22/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
1/3/2007: Policy reviewed, all medically necessary language removed as newer studies have shown no increase survival of patients with stem cell transplants after high-dose chemotherapy
1/4/2007: Code reference section updated; All CPT, HCPCS, and ICD-9 procedure codes moved to non-covered. Covered codes removed
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.27 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; Covered table - CPT-4 code 38230 added; ICD-9 Procedure 41.01, 41.09 added; HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added, J9000-J9999 deleted; Non-Covered table - CPT-4 code 38204, 86812, 86813, 86816, 86817, 86821, 86822 added, ICD-9 Procedure 41.02, 41.03 added
3/22/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
1/3/2007: Policy reviewed, all medically necessary language removed as newer studies have shown no increase survival of patients with stem cell transplants after high-dose chemotherapy
1/4/2007: Code reference section updated; All CPT, HCPCS, and ICD-9 procedure codes moved to non-covered. Covered codes removed
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0361 | Prolong chemo infuse>8hrs pu | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.27 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; Covered table - CPT-4 code 38230 added; ICD-9 Procedure 41.01, 41.09 added; HCPCS G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added, J9000-J9999 deleted; Non-Covered table - CPT-4 code 38204, 86812, 86813, 86816, 86817, 86821, 86822 added, ICD-9 Procedure 41.02, 41.03 added
3/22/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
1/3/2007: Policy reviewed, all medically necessary language removed as newer studies have shown no increase survival of patients with stem cell transplants after high-dose chemotherapy
1/4/2007: Code reference section updated; All CPT, HCPCS, and ICD-9 procedure codes moved to non-covered. Covered codes removed
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
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