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86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. |
86822 | Lymphocyte culture primed | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
38240 | Transplt allo hct/donor | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
38205 | PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
38242 | Transplt allo lymphocytes | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
86822 | Lymphocyte culture primed | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | POLICY HISTORY3/25/2004: 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 # 8.01.25 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC, no changes
10/19/2005: Code Reference section updated, codes G0355-G0364 added, 38204, 38205, 38240, 38242, 86812-86822, J9000-J9999 deleted; ICD9 procedure code 41.01, 41.09 added, 41.05, 41.08, 41.91 deleted; description of ICD9 procedure code 99.79 revised; HCPCS statement added on how to report J9000-J9999 codes. 03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
9/30/2008: Description updated, "high-dose chemotherapy" removed from policy title and statement. "Stem-cell support" wording replaced with "stem-cell transplantation". |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | Policy statement revised to change "stem-cell support" to "hematopoietic stem-cell transplantation" and state that autologous or allogeneic hematopoietic stem-cell transplantation is considered investigational. Policy intent unchanged. 08/21/2015: Code Reference section updated to add ICD-10 codes, removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. 03/09/2016: Policy description updated regarding FDA regulations. Policy statement unchanged. |
96445 | Chemotherapy, intracavitary | HCPCS | Policy statement revised to change "stem-cell support" to "hematopoietic stem-cell transplantation" and state that autologous or allogeneic hematopoietic stem-cell transplantation is considered investigational. Policy intent unchanged. 08/21/2015: Code Reference section updated to add ICD-10 codes, removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. 03/09/2016: Policy description updated regarding FDA regulations. Policy statement unchanged. |
96446 | PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH | HCPCS | Policy statement revised to change "stem-cell support" to "hematopoietic stem-cell transplantation" and state that autologous or allogeneic hematopoietic stem-cell transplantation is considered investigational. Policy intent unchanged. 08/21/2015: Code Reference section updated to add ICD-10 codes, removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. 03/09/2016: Policy description updated regarding FDA regulations. Policy statement unchanged. |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | Policy intent unchanged. 08/21/2015: Code Reference section updated to add ICD-10 codes, removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. 03/09/2016: Policy description updated regarding FDA regulations. Policy statement unchanged. Investigative definition updated in policy guidelines section. |
96445 | Chemotherapy, intracavitary | HCPCS | Policy intent unchanged. 08/21/2015: Code Reference section updated to add ICD-10 codes, removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. 03/09/2016: Policy description updated regarding FDA regulations. Policy statement unchanged. Investigative definition updated in policy guidelines section. |
96446 | PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH | HCPCS | Policy intent unchanged. 08/21/2015: Code Reference section updated to add ICD-10 codes, removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. 03/09/2016: Policy description updated regarding FDA regulations. Policy statement unchanged. Investigative definition updated in policy guidelines section. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | With this adoption, CMS mandated the use of HCPCS to report services for Part B of the Medicare Program. In October 1986, CMS also required state Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS mandated the use of CPT for reporting outpatient hospital surgical procedures. Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services. HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | In October 1986, CMS also required state Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS mandated the use of CPT for reporting outpatient hospital surgical procedures. Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services. HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. This includes transactions and code sets, national provider identifier, national employer identifier, security and privacy. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. This includes transactions and code sets, national provider identifier, national employer identifier, security and privacy. The Final Rule for transactions and code sets was issued on Aug. 17, 2000. The rule names CPT (including codes and modifiers) and HCPCS as the procedure code set for:
- Physician services
- Physical and occupational therapy services
- Radiological procedures
- Clinical laboratory tests
- Other medical diagnostic procedures
- Hearing and vision services
- Transportation services including ambulance
The Final Rule also named ICD-10 volumes 1 and 2 as the code set for diagnosis codes, ICD-10-CM volume 3 for inpatient hospital services, CDT for dental services and NDC codes for drugs. All health care plans and providers who transmit information electronically were required to use established national standards by the end of the implementation period, Oct. 16, 2003. |
1999 | ANESTHESIOLOGY GROUP | CPT | The primary reason for medical coding is to ensure consistent classification and billing, as it enables physicians, medical centers, and third-party payers to “talk” in the same language. So where do these codes come from? There are four major “code sets” in the medical coding world, each with a different use:
- International Statistical Classification of Diseases and Related Health Problems (ICD), maintained by the World Health Organization
- International Statistical Classification of Diseases and Related Health Problems, Clinical Modification (ICD-CM), maintained by the Centers for Medicare and Medicaid Services and the National Center for Health Statistics
- Healthcare Common Procedure Coding System (HCPCS), maintained by the Centers for Medicare and Medicaid Services
- Current Procedural Terminology (CPT), maintained by the American Medical Association
Here’s how they fit together:
ICD-9: The ninth revision of the ICD code set, ICD-9 was used to classify mortality (death) in the U.S. until Jan. 1, 1999, and is now obsolete (replaced by ICD-10). ICD-9-CM: The ninth revision of the ICD code set with “clinical modifications,” ICD-9-CM is used today in the U.S. to classify morbidity (diagnoses/diseases) and inpatient medical procedures. It consists of three volumes: volume one (tabular listing of diagnosis codes), volume two (index of diagnosis codes), and volume three (procedure codes). |
1999 | ANESTHESIOLOGY GROUP | CPT | So where do these codes come from? There are four major “code sets” in the medical coding world, each with a different use:
- International Statistical Classification of Diseases and Related Health Problems (ICD), maintained by the World Health Organization
- International Statistical Classification of Diseases and Related Health Problems, Clinical Modification (ICD-CM), maintained by the Centers for Medicare and Medicaid Services and the National Center for Health Statistics
- Healthcare Common Procedure Coding System (HCPCS), maintained by the Centers for Medicare and Medicaid Services
- Current Procedural Terminology (CPT), maintained by the American Medical Association
Here’s how they fit together:
ICD-9: The ninth revision of the ICD code set, ICD-9 was used to classify mortality (death) in the U.S. until Jan. 1, 1999, and is now obsolete (replaced by ICD-10). ICD-9-CM: The ninth revision of the ICD code set with “clinical modifications,” ICD-9-CM is used today in the U.S. to classify morbidity (diagnoses/diseases) and inpatient medical procedures. It consists of three volumes: volume one (tabular listing of diagnosis codes), volume two (index of diagnosis codes), and volume three (procedure codes). An ICD-9-CM code has between three and five characters, such as 560, 553.3, or 560.81. |
39520 | Repair of diaphragm hernia | HCPCS | When you hear rumblings that medical centers are anxious about planned ICD changes, it’s this forthcoming implementation of ICD-10-CM across the U.S. that’s causing the angst. HCPCS: A two-level code set used to classify outpatient medical procedures. Level one consists of CPT codes (see below), while level two classifies non-physician services and supplies, such as ambulance transportation and medical equipment. CPT: Serves as HCPCS level one and is used in the U.S. today to classify all outpatient medical and surgical procedures (ICD-9-CM volume three is used to classify inpatient procedures). A CPT code has five digits, such as 39520 or 00756. |
00756 | Anesth repair of hernia | CPT | When you hear rumblings that medical centers are anxious about planned ICD changes, it’s this forthcoming implementation of ICD-10-CM across the U.S. that’s causing the angst. HCPCS: A two-level code set used to classify outpatient medical procedures. Level one consists of CPT codes (see below), while level two classifies non-physician services and supplies, such as ambulance transportation and medical equipment. CPT: Serves as HCPCS level one and is used in the U.S. today to classify all outpatient medical and surgical procedures (ICD-9-CM volume three is used to classify inpatient procedures). A CPT code has five digits, such as 39520 or 00756. |
39520 | Repair of diaphragm hernia | HCPCS | HCPCS: A two-level code set used to classify outpatient medical procedures. Level one consists of CPT codes (see below), while level two classifies non-physician services and supplies, such as ambulance transportation and medical equipment. CPT: Serves as HCPCS level one and is used in the U.S. today to classify all outpatient medical and surgical procedures (ICD-9-CM volume three is used to classify inpatient procedures). A CPT code has five digits, such as 39520 or 00756. A subset of CPT codes, called evaluation and management (E&M) codes, are used to classify non-surgical physician visits/consultations. |
00756 | Anesth repair of hernia | CPT | HCPCS: A two-level code set used to classify outpatient medical procedures. Level one consists of CPT codes (see below), while level two classifies non-physician services and supplies, such as ambulance transportation and medical equipment. CPT: Serves as HCPCS level one and is used in the U.S. today to classify all outpatient medical and surgical procedures (ICD-9-CM volume three is used to classify inpatient procedures). A CPT code has five digits, such as 39520 or 00756. A subset of CPT codes, called evaluation and management (E&M) codes, are used to classify non-surgical physician visits/consultations. |
39520 | Repair of diaphragm hernia | HCPCS | Level one consists of CPT codes (see below), while level two classifies non-physician services and supplies, such as ambulance transportation and medical equipment. CPT: Serves as HCPCS level one and is used in the U.S. today to classify all outpatient medical and surgical procedures (ICD-9-CM volume three is used to classify inpatient procedures). A CPT code has five digits, such as 39520 or 00756. A subset of CPT codes, called evaluation and management (E&M) codes, are used to classify non-surgical physician visits/consultations. Put another way, in the U.S. today …
- ICD-9-CM volumes one and two are used to classify morbidity
- ICD-9-CM volume three is used to classify inpatient hospital procedures
- ICD-10 is used to classify mortality
- HCPCS level one (CPT) is used to classify outpatient procedures
- HCPCS level two is used to classify medical equipment, supplies, and drugs
The intersection of medical coding and health care information technology — pmFAQtory’s field — is pretty clear-cut. |
00756 | Anesth repair of hernia | CPT | Level one consists of CPT codes (see below), while level two classifies non-physician services and supplies, such as ambulance transportation and medical equipment. CPT: Serves as HCPCS level one and is used in the U.S. today to classify all outpatient medical and surgical procedures (ICD-9-CM volume three is used to classify inpatient procedures). A CPT code has five digits, such as 39520 or 00756. A subset of CPT codes, called evaluation and management (E&M) codes, are used to classify non-surgical physician visits/consultations. Put another way, in the U.S. today …
- ICD-9-CM volumes one and two are used to classify morbidity
- ICD-9-CM volume three is used to classify inpatient hospital procedures
- ICD-10 is used to classify mortality
- HCPCS level one (CPT) is used to classify outpatient procedures
- HCPCS level two is used to classify medical equipment, supplies, and drugs
The intersection of medical coding and health care information technology — pmFAQtory’s field — is pretty clear-cut. |
39520 | Repair of diaphragm hernia | HCPCS | CPT: Serves as HCPCS level one and is used in the U.S. today to classify all outpatient medical and surgical procedures (ICD-9-CM volume three is used to classify inpatient procedures). A CPT code has five digits, such as 39520 or 00756. A subset of CPT codes, called evaluation and management (E&M) codes, are used to classify non-surgical physician visits/consultations. Put another way, in the U.S. today …
- ICD-9-CM volumes one and two are used to classify morbidity
- ICD-9-CM volume three is used to classify inpatient hospital procedures
- ICD-10 is used to classify mortality
- HCPCS level one (CPT) is used to classify outpatient procedures
- HCPCS level two is used to classify medical equipment, supplies, and drugs
The intersection of medical coding and health care information technology — pmFAQtory’s field — is pretty clear-cut. For humans, sorting through various code sets and tens of thousands of individual medical codes, while at the same time ensuring compliance with payer regulations, is about as much fun as doing taxes by hand. |
00756 | Anesth repair of hernia | CPT | CPT: Serves as HCPCS level one and is used in the U.S. today to classify all outpatient medical and surgical procedures (ICD-9-CM volume three is used to classify inpatient procedures). A CPT code has five digits, such as 39520 or 00756. A subset of CPT codes, called evaluation and management (E&M) codes, are used to classify non-surgical physician visits/consultations. Put another way, in the U.S. today …
- ICD-9-CM volumes one and two are used to classify morbidity
- ICD-9-CM volume three is used to classify inpatient hospital procedures
- ICD-10 is used to classify mortality
- HCPCS level one (CPT) is used to classify outpatient procedures
- HCPCS level two is used to classify medical equipment, supplies, and drugs
The intersection of medical coding and health care information technology — pmFAQtory’s field — is pretty clear-cut. For humans, sorting through various code sets and tens of thousands of individual medical codes, while at the same time ensuring compliance with payer regulations, is about as much fun as doing taxes by hand. |
39520 | Repair of diaphragm hernia | HCPCS | A CPT code has five digits, such as 39520 or 00756. A subset of CPT codes, called evaluation and management (E&M) codes, are used to classify non-surgical physician visits/consultations. Put another way, in the U.S. today …
- ICD-9-CM volumes one and two are used to classify morbidity
- ICD-9-CM volume three is used to classify inpatient hospital procedures
- ICD-10 is used to classify mortality
- HCPCS level one (CPT) is used to classify outpatient procedures
- HCPCS level two is used to classify medical equipment, supplies, and drugs
The intersection of medical coding and health care information technology — pmFAQtory’s field — is pretty clear-cut. For humans, sorting through various code sets and tens of thousands of individual medical codes, while at the same time ensuring compliance with payer regulations, is about as much fun as doing taxes by hand. That’s why numerous technological solutions have surfaced to help medical centers more efficiently assign codes and ensure accuracy. |
00756 | Anesth repair of hernia | CPT | A CPT code has five digits, such as 39520 or 00756. A subset of CPT codes, called evaluation and management (E&M) codes, are used to classify non-surgical physician visits/consultations. Put another way, in the U.S. today …
- ICD-9-CM volumes one and two are used to classify morbidity
- ICD-9-CM volume three is used to classify inpatient hospital procedures
- ICD-10 is used to classify mortality
- HCPCS level one (CPT) is used to classify outpatient procedures
- HCPCS level two is used to classify medical equipment, supplies, and drugs
The intersection of medical coding and health care information technology — pmFAQtory’s field — is pretty clear-cut. For humans, sorting through various code sets and tens of thousands of individual medical codes, while at the same time ensuring compliance with payer regulations, is about as much fun as doing taxes by hand. That’s why numerous technological solutions have surfaced to help medical centers more efficiently assign codes and ensure accuracy. |
1745 | Thoracoscopic robotic assisted procedure | ICD | doi:10.1016/j.biopsych.2006.08.041. PMID 17141745. - World Health Organisation (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. |
1745 | Thoracoscopic robotic assisted procedure | ICD | PMID 17141745. - World Health Organisation (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. ISBN 978-92-4-154422-1. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
Q2035 | PR AFLURIA VACC, 3 YRS & >, IM | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
Q2039 | PR INFLUENZA VIRUS VACCINE, NOS | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
90672 | INTRANASAL ADMIN FOR FLU VAX | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
90655 | Iiv3 vacc no prsv 0.25 ml im | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
90688 | HC IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
90630 | HC INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
90661 | HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
Q2036 | Flulaval vacc, 3 yrs & >, im | HCPCS | - Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older. Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are. Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
Q2035 | PR AFLURIA VACC, 3 YRS & >, IM | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
Q2039 | PR INFLUENZA VIRUS VACCINE, NOS | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
90672 | INTRANASAL ADMIN FOR FLU VAX | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
90655 | Iiv3 vacc no prsv 0.25 ml im | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
90688 | HC IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
G0008 | PR ADMIN INFLUENZA VIRUS VAC | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
90630 | HC INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
90661 | HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
Q2036 | Flulaval vacc, 3 yrs & >, im | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
G0009 | PR ADMIN PNEUMOCOCCAL VACCINE | HCPCS | Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. |
90653 | HC FLU VACCINE ADJUVANT IM | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
Q2035 | PR AFLURIA VACC, 3 YRS & >, IM | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
Q2039 | PR INFLUENZA VIRUS VACCINE, NOS | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
90672 | INTRANASAL ADMIN FOR FLU VAX | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
90655 | Iiv3 vacc no prsv 0.25 ml im | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
90688 | HC IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
G0008 | PR ADMIN INFLUENZA VIRUS VAC | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
90630 | HC INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
90661 | HC CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
Q2036 | Flulaval vacc, 3 yrs & >, im | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
G0009 | PR ADMIN PNEUMOCOCCAL VACCINE | HCPCS | For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine. Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | With this adoption, CMS mandated the use of HCPCS to report services for Part B of the Medicare Program. In October 1986, CMS also required state Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS mandated the use of CPT for reporting outpatient hospital surgical procedures. Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services. HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | In October 1986, CMS also required state Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS mandated the use of CPT for reporting outpatient hospital surgical procedures. Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services. HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. This includes transactions and code sets, national provider identifier, national employer identifier, security and privacy. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. This includes transactions and code sets, national provider identifier, national employer identifier, security and privacy. The Final Rule for transactions and code sets was issued on Aug. 17, 2000. The rule names CPT (including codes and modifiers) and HCPCS as the procedure code set for:
- Physician services
- Physical and occupational therapy services
- Radiological procedures
- Clinical laboratory tests
- Other medical diagnostic procedures
- Hearing and vision services
- Transportation services including ambulance
The Final Rule also named ICD-10 volumes 1 and 2 as the code set for diagnosis codes, ICD-10-CM volume 3 for inpatient hospital services, CDT for dental services and NDC codes for drugs. All health care plans and providers who transmit information electronically were required to use established national standards by the end of the implementation period, Oct. 16, 2003. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | For the procedure, we’d code 23140 for “excision or curretage of bone cyst or benign tumor, humerus; with autograft (includes obtaining the graft).” Since the procedure was completed but not fully successful, we’d add the -52 modifier, for reduced services, to the code, and we’d end up with 23140-52. Physical Status Modifier (for Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. Note that there may be some overlap or contradiction with the set of HCPCS modifiers, which we’ll cover in more depth later on. |
1745 | Thoracoscopic robotic assisted procedure | ICD | doi:10.1016/j.biopsych.2006.08.041. PMID 17141745. - World Health Organisation (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. |
1745 | Thoracoscopic robotic assisted procedure | ICD | PMID 17141745. - World Health Organisation (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. ISBN 978-92-4-154422-1. |
A4639 | Replacement pad for infrared heating pad system, each | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
1999 | ANESTHESIOLOGY GROUP | CPT | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
E0692 | Uvl sys panel 4 ft | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
97028 | Ultraviolet therapy | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
S9098 | Home phototherapy visit | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
E0202 | Phototherapy light w/ photom | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
A4634 | Replacement bulb th lightbox | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
E0694 | Uvl md cabinet sys 6 ft | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
E0691 | Uvl pnl 2 sq ft or less | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
A4633 | Uvl replacement bulb | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
E0690 | UV CABINET APPROPRIATE HOME USE | CPT | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
E0693 | Uvl sys panel 6 ft | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. |
A4639 | Replacement pad for infrared heating pad system, each | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
1999 | ANESTHESIOLOGY GROUP | CPT | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
E0692 | Uvl sys panel 4 ft | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
97028 | Ultraviolet therapy | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
S9098 | Home phototherapy visit | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
E0202 | Phototherapy light w/ photom | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
A4634 | Replacement bulb th lightbox | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
E0694 | Uvl md cabinet sys 6 ft | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
E0691 | Uvl pnl 2 sq ft or less | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
A4633 | Uvl replacement bulb | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
E0690 | UV CABINET APPROPRIATE HOME USE | CPT | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
E0693 | Uvl sys panel 6 ft | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Investigational indication of seasonal affective disorder approved by (MPAC)
8/1999: Revisions approved by MPAC
2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added
5/2/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 procedure codes 99.82 and 99.83 added
2/19/2003: Description of E0202 and E0690 updated to be consistent with AMA
3/11/2003: Code Reference section updated
6/27/2003: HCPCS A4633, A4634 deleted, replacement included in rental
12/6/2004: Code Reference section updated, CPT 97028 added, ICD-9 diagnosis code 202.1 5th digit added and description revised, ICD-9 diagnosis 696.8, 698.9 added, HCPCS A4633, S9098 added, HCPCS A4639, E0690 deleted, HCPCS E0691, E0692, E0693, E0694 effective date added
10/24/2006: Policy reviewed, seasonal affective disorder changed from investigational to medically necessary. 10/30/2006: Code reference section updated. ICD-9 diagnosis code 296.99 added to table. 03/16/2011: The policy statement regarding home ultraviolet light was revised to remove the requirement for a documented response to UVL. |
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