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G6016 | PR DELIVERY COMP IMRT | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.46
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
G6015 | Radiation tx delivery imrt | HCPCS | Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.46
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.46
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
93784 | PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R | HCPCS | ABPM is also used for monitoring patients with established hypertension under treatment, evaluating refractory or resistant BP, checking whether symptoms such as lightheadedness correspond with blood pressure changes and also for examining diurnal patterns of BP. However, ABPM is indicated for diagnostic purposes only and should not be used for maintenance monitoring. Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. |
93786 | PR AMBULATORY BP MNTR W/SW 24 HR+ RECORDING ONLY | HCPCS | ABPM is also used for monitoring patients with established hypertension under treatment, evaluating refractory or resistant BP, checking whether symptoms such as lightheadedness correspond with blood pressure changes and also for examining diurnal patterns of BP. However, ABPM is indicated for diagnostic purposes only and should not be used for maintenance monitoring. Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. |
93788 | PR AMBULATORY BP MNTR W/SW 24 HR+ SCANNING A/R | HCPCS | ABPM is also used for monitoring patients with established hypertension under treatment, evaluating refractory or resistant BP, checking whether symptoms such as lightheadedness correspond with blood pressure changes and also for examining diurnal patterns of BP. However, ABPM is indicated for diagnostic purposes only and should not be used for maintenance monitoring. Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. |
93790 | PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R | HCPCS | ABPM is also used for monitoring patients with established hypertension under treatment, evaluating refractory or resistant BP, checking whether symptoms such as lightheadedness correspond with blood pressure changes and also for examining diurnal patterns of BP. However, ABPM is indicated for diagnostic purposes only and should not be used for maintenance monitoring. Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. |
93784 | PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R | HCPCS | However, ABPM is indicated for diagnostic purposes only and should not be used for maintenance monitoring. Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. |
93786 | PR AMBULATORY BP MNTR W/SW 24 HR+ RECORDING ONLY | HCPCS | However, ABPM is indicated for diagnostic purposes only and should not be used for maintenance monitoring. Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. |
93788 | PR AMBULATORY BP MNTR W/SW 24 HR+ SCANNING A/R | HCPCS | However, ABPM is indicated for diagnostic purposes only and should not be used for maintenance monitoring. Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. |
93790 | PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R | HCPCS | However, ABPM is indicated for diagnostic purposes only and should not be used for maintenance monitoring. Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. |
93788 | PR AMBULATORY BP MNTR W/SW 24 HR+ SCANNING A/R | HCPCS | Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. |
93784 | PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R | HCPCS | Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. |
93786 | PR AMBULATORY BP MNTR W/SW 24 HR+ RECORDING ONLY | HCPCS | Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. |
A4670 | Automatic bp monitor, dial | HCPCS | Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. |
93790 | PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R | HCPCS | Though ABPM does not require authorization or prior authorization, it is critical to use the right CPT, ICD-10 and HCPCS codes. There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. |
93788 | PR AMBULATORY BP MNTR W/SW 24 HR+ SCANNING A/R | HCPCS | There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
93784 | PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R | HCPCS | There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
93786 | PR AMBULATORY BP MNTR W/SW 24 HR+ RECORDING ONLY | HCPCS | There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
A4670 | Automatic bp monitor, dial | HCPCS | There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
93790 | PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R | HCPCS | There are four current procedural terminology (CPT) codes related to ambulatory blood pressure monitoring:
- 93784: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790: Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report
Although there are four CPT codes related to ABPM, only three of them are covered by Medicare. It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
93784 | PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R | HCPCS | It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
93786 | PR AMBULATORY BP MNTR W/SW 24 HR+ RECORDING ONLY | HCPCS | It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
A4670 | Automatic bp monitor, dial | HCPCS | It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
93790 | PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R | HCPCS | It is recommended to use code 93784 when you provide both the technical and professional components. The code 93786 can be used when you provide the technical component only and use the code 93790, when providing the professional component only. Applicable Common Procedure Coding System (HCPCS) code for ABPM for suspected WCH is
- A4670 Automatic blood pressure monitor
Covered ICD-10-CM Diagnosis Codes for ABPM include:
- I10: Essential (primary) hypertension
- I11.9: Hypertensive heart disease without heart failure
- I20.8: Other Forms of Angina Pectoris
- I95.1: Orthostatic Hypotension
- R03.0: Elevated blood pressure reading, without diagnosis of hypertension
- R55: Syncope and collapse
- Z01.30: Encounter for examination of blood pressure without abnormal findings
- Z01.31: Encounter for examination of blood pressure with abnormal findings
For the Medicare Advantage Policy, Place of Service Codes for ABPM include:
- 11: Office
- 12: Home
- 13: Assisted Living Facility
- 14: Group Home
- 19: Off Campus-Outpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
- 32: Nursing Facility
- 33: Custodial Care Facility
- 49: Independent Clinic
- 50: Federally Qualified Health Center
- 71: Public Health Clinic
- 72: Rural Health Clinic
It is important to remember that ABPM must be performed for at least 24 hours to meet coverage criteria. Medical billing and coding services provided by reliable companies are based on the standard guidelines for ABPM coverage. |
G6015 | Radiation tx delivery imrt | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. |
77386 | HC IMRT COMPLEX | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. |
77385 | HC IMRT SIMPLE | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. |
G6015 | Radiation tx delivery imrt | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. |
77386 | HC IMRT COMPLEX | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. |
77385 | HC IMRT SIMPLE | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. |
G6015 | Radiation tx delivery imrt | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statements unchanged. |
77386 | HC IMRT COMPLEX | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statements unchanged. |
77385 | HC IMRT SIMPLE | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statements unchanged. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statements unchanged. |
G6015 | Radiation tx delivery imrt | HCPCS | Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statements unchanged. Policy Guidelines section updated to add medically necessary and investigative definitions. |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statements unchanged. Policy Guidelines section updated to add medically necessary and investigative definitions. |
1999 | ANESTHESIOLOGY GROUP | CPT | - Ophthalmic Technology Assessment Committee Cornea Panel American Academy of Ophthalmology. Corneal topography. Ophthalmology 1999; 106(8-Jan):1628-38. |CPT||92025||Computerized corneal topography, unilateral or bilateral, with interpretation and report|
|92002–92014||General ophthalmological services|
|ICD-9 Procedure||95.02||Comprehensive eye examination|
|95.09||Eye examination, not otherwise specified|
|ICD-9 Diagnosis||Not medically necessary for all diagnoses|
|ICD-10-CM (effective 10/01/15)||Not medically necessary for all diagnoses|
|H16.001-H16.9||Keratitis code range|
|H17.00-H17.9||Corneal scars and opacities code range|
|H18.001-H18.9||Other disorders of cornea code range|
|ICD-10-PCS (effective 10/01/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this examination.|
|08J0XZZ, 08J1XZZ||Eye examination, code by body part (right eye or left eye)|
|Type of Service||Ophthalmology|
|Place of Service||Physician’s Office|
|11/1/97||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature review; new review date only|
|10/09/03||Replace policy||Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled|
|10/10/2006||Replace policy||Policy updated with literature review. |
1999 | ANESTHESIOLOGY GROUP | CPT | Corneal topography. Ophthalmology 1999; 106(8-Jan):1628-38. |CPT||92025||Computerized corneal topography, unilateral or bilateral, with interpretation and report|
|92002–92014||General ophthalmological services|
|ICD-9 Procedure||95.02||Comprehensive eye examination|
|95.09||Eye examination, not otherwise specified|
|ICD-9 Diagnosis||Not medically necessary for all diagnoses|
|ICD-10-CM (effective 10/01/15)||Not medically necessary for all diagnoses|
|H16.001-H16.9||Keratitis code range|
|H17.00-H17.9||Corneal scars and opacities code range|
|H18.001-H18.9||Other disorders of cornea code range|
|ICD-10-PCS (effective 10/01/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this examination.|
|08J0XZZ, 08J1XZZ||Eye examination, code by body part (right eye or left eye)|
|Type of Service||Ophthalmology|
|Place of Service||Physician’s Office|
|11/1/97||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature review; new review date only|
|10/09/03||Replace policy||Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled|
|10/10/2006||Replace policy||Policy updated with literature review. Policy statement revised.|
|12/13/07||Replace Policy||Policy updated with literature review; reference 3 added; policy statement unchanged.|
|04/24/09||Replace policy||Policy updated with literature review through January 2009; policy statement changed to not medically necessary.|
|04/08/10||Replace policy||Policy updated with literature review through February 2010; reference 3 added; policy statement unchanged|
|4/14/11||Replace policy||Policy updated with literature review through February 2011; policy statement unchanged|
|04/12/12||Replace policy||Policy updated with literature review through February 2012; policy statement unchanged|
|04/11/13||Replace policy||Policy updated with literature review through March 13, 2013; reference 4 added; policy statement unchanged|
|4/10/14||Replace policy||Policy updated with literature review through March 3, 2014; policy statement unchanged| |
1999 | ANESTHESIOLOGY GROUP | CPT | Ophthalmology 1999; 106(8-Jan):1628-38. |CPT||92025||Computerized corneal topography, unilateral or bilateral, with interpretation and report|
|92002–92014||General ophthalmological services|
|ICD-9 Procedure||95.02||Comprehensive eye examination|
|95.09||Eye examination, not otherwise specified|
|ICD-9 Diagnosis||Not medically necessary for all diagnoses|
|ICD-10-CM (effective 10/01/15)||Not medically necessary for all diagnoses|
|H16.001-H16.9||Keratitis code range|
|H17.00-H17.9||Corneal scars and opacities code range|
|H18.001-H18.9||Other disorders of cornea code range|
|ICD-10-PCS (effective 10/01/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this examination.|
|08J0XZZ, 08J1XZZ||Eye examination, code by body part (right eye or left eye)|
|Type of Service||Ophthalmology|
|Place of Service||Physician’s Office|
|11/1/97||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature review; new review date only|
|10/09/03||Replace policy||Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled|
|10/10/2006||Replace policy||Policy updated with literature review. Policy statement revised.|
|12/13/07||Replace Policy||Policy updated with literature review; reference 3 added; policy statement unchanged.|
|04/24/09||Replace policy||Policy updated with literature review through January 2009; policy statement changed to not medically necessary.|
|04/08/10||Replace policy||Policy updated with literature review through February 2010; reference 3 added; policy statement unchanged|
|4/14/11||Replace policy||Policy updated with literature review through February 2011; policy statement unchanged|
|04/12/12||Replace policy||Policy updated with literature review through February 2012; policy statement unchanged|
|04/11/13||Replace policy||Policy updated with literature review through March 13, 2013; reference 4 added; policy statement unchanged|
|4/10/14||Replace policy||Policy updated with literature review through March 3, 2014; policy statement unchanged| |
53899 | HC UNLISTED PROCEDURE, URINARY SYSTEM | HCPCS | Revisions approved per Medical Policy Advisory Committee (MPAC)
6/21/2006.Coding reference section updated, 76940 added to covered table, 50549, 50592, 53899, 55.39 moved to non-covered table. 85.20 added to non-covered table. 189.0 deleted. 9/22/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
6/20/2007: Policy reviewed, no changes
7/19/2007: Reviewed and approved by MPAC
7/18/2008: Anesthesia Coding Policy hyperlink added
07/30/2010: Policy description updated regarding new treatment approaches and recent research findings. |
50592 | PR ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY | HCPCS | Revisions approved per Medical Policy Advisory Committee (MPAC)
6/21/2006.Coding reference section updated, 76940 added to covered table, 50549, 50592, 53899, 55.39 moved to non-covered table. 85.20 added to non-covered table. 189.0 deleted. 9/22/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
6/20/2007: Policy reviewed, no changes
7/19/2007: Reviewed and approved by MPAC
7/18/2008: Anesthesia Coding Policy hyperlink added
07/30/2010: Policy description updated regarding new treatment approaches and recent research findings. |
50549 | Unlisted laps px renal | HCPCS | Revisions approved per Medical Policy Advisory Committee (MPAC)
6/21/2006.Coding reference section updated, 76940 added to covered table, 50549, 50592, 53899, 55.39 moved to non-covered table. 85.20 added to non-covered table. 189.0 deleted. 9/22/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
6/20/2007: Policy reviewed, no changes
7/19/2007: Reviewed and approved by MPAC
7/18/2008: Anesthesia Coding Policy hyperlink added
07/30/2010: Policy description updated regarding new treatment approaches and recent research findings. |
76940 | HC ULTRASOUND GUIDANCE FOR, AND MONITORING OF, PARENCHYMAL TISSU | HCPCS | Revisions approved per Medical Policy Advisory Committee (MPAC)
6/21/2006.Coding reference section updated, 76940 added to covered table, 50549, 50592, 53899, 55.39 moved to non-covered table. 85.20 added to non-covered table. 189.0 deleted. 9/22/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
6/20/2007: Policy reviewed, no changes
7/19/2007: Reviewed and approved by MPAC
7/18/2008: Anesthesia Coding Policy hyperlink added
07/30/2010: Policy description updated regarding new treatment approaches and recent research findings. |
1999 | ANESTHESIOLOGY GROUP | CPT | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
S2120 | Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36511 | PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36513 | PR THERAPEUTIC APHERESIS PLATELETS | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36512 | PR THERAPEUTIC APHERESIS RED BLOOD CELLS | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36521 | USE 36516 | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
36520 | SEE 36511-36512 | HCPCS | POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. |
1999 | ANESTHESIOLOGY GROUP | CPT | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
S2120 | Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
36511 | PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
36513 | PR THERAPEUTIC APHERESIS PLATELETS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
36512 | PR THERAPEUTIC APHERESIS RED BLOOD CELLS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
36521 | USE 36516 | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
36520 | SEE 36511-36512 | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. |
1999 | ANESTHESIOLOGY GROUP | CPT | POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. |
S2120 | Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation | HCPCS | POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. |
36511 | PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS | HCPCS | POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. |
36513 | PR THERAPEUTIC APHERESIS PLATELETS | HCPCS | POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. |
36512 | PR THERAPEUTIC APHERESIS RED BLOOD CELLS | HCPCS | POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. |
36521 | USE 36516 | HCPCS | POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. |
36520 | SEE 36511-36512 | HCPCS | POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. |
36522 | PR PHOTOPHERESIS EXTRACORPOREAL | HCPCS | IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. |
S2120 | Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation | HCPCS | IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. |
86960 | HC VOL REDUC BLD/PRD EA UN | HCPCS | IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. |
36516 | PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION | HCPCS | IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. |
36515 | Apheresis adsorp/reinfuse | HCPCS | IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. |
36522 | PR PHOTOPHERESIS EXTRACORPOREAL | HCPCS | Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational. |
S2120 | Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation | HCPCS | Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational. |
86960 | HC VOL REDUC BLD/PRD EA UN | HCPCS | Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational. |
36516 | PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION | HCPCS | Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational. |
36515 | Apheresis adsorp/reinfuse | HCPCS | Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational. |
E0472 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pre | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7035 | Pos airway press headgear | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7038 | Pos airway pressure filter | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7032 | Replacement nasal cushion | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7028 | Repl oral cushion combo mask | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7045 | Repl exhalation port for PAP | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7044 | PAP oral interface | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A4604 | Tubing with integrated heating element for use with positive airway pressure device | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
E1399 | ITEM 6664 | CPT | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7029 | Repl nasal pillow comb mask | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
E0562 | Humidifier heated used w PAP | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
E0601 | Continuous positive airway pressure (cpap) device | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
E0471 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive air | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7031 | Replacement facemask interfa | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7039 | Filter, non disposable w pap | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7037 | Tubing used with positive airway pressure device | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7033 | Replacement nasal pillows | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7046 | Water chamber for humidifier, used with positive airway pressure device, replacement, each | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
E0470 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive a | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7027 | Combination oral/nasal mask, used with continuous positive airway pressure device, each | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
E0561 | Humidifier nonheated w PAP | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
A7034 | Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap | HCPCS | Insurance policies vary. Be sure to check with your specific provider before making any purchases. Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. |
E0472 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pre | HCPCS | Below is a list of the HCPCS Codes and medicare guidelines for replacement schedule:
HCPCS Code Product Replacement Schedule E0601 CPAP/APAP machine 1 per 5 Years E0470 BiPAP machine without backup rate feature 1 per 5 Years E0471 BiPAP-ST machine with backup rate feature 1 per 5 Years E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, with backup rate feature 1 per 5 Years E0561 Humidifier, Non-Heated 1 per 5 Years E0562 CPAP Heated Humidifier 1 per 5 Years A7046 CPAP Humidifier (Water) Chamber 1 per 6 months A7029 Replacement Pillows for Combination Oral/Nasal Mask 1 per month A7034 Nasal Mask (mask or cannula/pillow type) 1 per 3 months A7044 Oral Interface 1 per 3 months A7027 Combination Oral/Nasal Mask 1 per 3 months A7028 Replacement Cushion for Combination Oral/Nasal Mask 1 per month A7031 Replacement Cushion for Full-Face Mask 1 per month A7032 Replacement Cushion for Nasal Mask 2 per month A7033 Replacement Pillow for use on Nasal Mask (cannula/pillow) 2 per month A7037 Tubing, Standard 1 per 3 months A4604 Tubing with Integrated Heating Element 1 per 3 months A7038 Disposable Filter 2 per month A7039 Non Disposable Filter 1 per 6 months A7045 CPAP Exhalation port with or without swivel 1 per 6 months A7035 CPAP headgear 1 per 6 months E1399 Miscellaneous Durable Medical Equipment Items, Components and Accessories (items covered by insurance not listed individually); ie, hose lift, tubing brush, etc. Varies
The following criteria needed to check on with insurance for coverage:
Also find out what percentage of the cost insurance covers and what the co-pay will be. The following information will be provided on a Respshop.com invoice:
Diagnosis/ICD-10-CM code: G47.30 Unspecified Sleep Apnea
G47.33 Obstructive Sleep Apnea (Adult) (Pediatric)
Tax ID, and CPT*/HCPC* codes. Copy of the claim form may need to be requested from the insurance company. Below is a link to the universal claim form:
Date of Discharge or Date of Service
Claim Submission Date ICD Code Set Required ICD Indicator in Field 21 10/1/2012-9/30/2015 10/1/2012-9/30/2015 ICD-09 None* 10/1/2012-9/30/2015 10/1/2015-beyond ICD-09 9 10/1/2015-beyond 10/1/2015-beyond ICD-10 0
*Leaving this field blank, or entering a "space" will default the claim to ICD-09. |
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