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A7035 | Pos airway press headgear | 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. |
A7038 | Pos airway pressure filter | 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. |
A7032 | Replacement nasal cushion | 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. |
A7028 | Repl oral cushion combo mask | 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. |
A7045 | Repl exhalation port for PAP | 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. |
A7044 | PAP oral interface | 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. |
A4604 | Tubing with integrated heating element for use with positive airway pressure device | 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. |
E1399 | ITEM 6664 | CPT | 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. |
A7029 | Repl nasal pillow comb mask | 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. |
E0562 | Humidifier heated used w PAP | 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. |
E0601 | Continuous positive airway pressure (cpap) device | 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. |
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 | 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. |
A7031 | Replacement facemask interfa | 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. |
A7039 | Filter, non disposable w pap | 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. |
A7037 | Tubing used with positive airway pressure device | 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. |
A7033 | Replacement nasal pillows | 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. |
A7046 | Water chamber for humidifier, used with positive airway pressure device, replacement, each | 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. |
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 | 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. |
A7027 | Combination oral/nasal mask, used with continuous positive airway pressure device, each | 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. |
E0561 | Humidifier nonheated w PAP | 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. |
A7034 | Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap | 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. |
A5120 | Skin barrier, wipes or swabs, each | HCPCS | HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. |
K0011 | Stnd wt pwr whlchr w control | HCPCS | HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. |
Q4011 | Cast sup sht arm ped plaster | HCPCS | HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. |
A5120 | Skin barrier, wipes or swabs, each | HCPCS | Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. |
K0011 | Stnd wt pwr whlchr w control | HCPCS | Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. |
Q4011 | Cast sup sht arm ped plaster | HCPCS | Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. |
A5120 | Skin barrier, wipes or swabs, each | HCPCS | HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book. |
K0011 | Stnd wt pwr whlchr w control | HCPCS | HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book. |
Q4011 | Cast sup sht arm ped plaster | HCPCS | HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book. |
L0100 | CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." |
97799 | Unlisted physcl med/rehab px | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." |
97703 | PROSTHETIC CHECKOUT | CPT | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." |
L0110 | CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." |
S1040 | Cranial remolding orthosis | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." |
L0100 | CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL | 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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. |
97799 | Unlisted physcl med/rehab px | 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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. |
97703 | PROSTHETIC CHECKOUT | 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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. |
L0110 | CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED | 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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. |
S1040 | Cranial remolding orthosis | 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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. |
L0100 | CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL | HCPCS | POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. |
97799 | Unlisted physcl med/rehab px | HCPCS | POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. |
97703 | PROSTHETIC CHECKOUT | CPT | POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. |
L0110 | CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED | HCPCS | POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. |
S1040 | Cranial remolding orthosis | HCPCS | POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110
8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. |
L0100 | CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL | HCPCS | 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged. |
S1040 | Cranial remolding orthosis | HCPCS | 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged. |
97799 | Unlisted physcl med/rehab px | HCPCS | 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged. |
L0110 | CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED | HCPCS | 10/17/2001: Sources and Code Reference sections updated
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
9/20/2002: Policy statement revised
10/11/2002: HCPCS S1040 added
5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised
6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11
8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted
3/22/2006: Coding updated. CPT4 2006 revisions added to policy
3/28/2006: Policy reviewed, no changes
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
4/24/2007: Policy reviewed, no changes
12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged. |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | Answers to the “quiz”
Code Source Term 1. 55454-3 LOINC Hemoglobin A1C 2. 250.02 ICD-9-CM Diabetes Mellitus without complications 3. E11.9 ICD-10-CM Type 2 Diabetes Mellitus without Complications 4. 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | 55454-3 LOINC Hemoglobin A1C 2. 250.02 ICD-9-CM Diabetes Mellitus without complications 3. E11.9 ICD-10-CM Type 2 Diabetes Mellitus without Complications 4. 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. 3E013VG ICD-10-PCS Intro of Insulin into SubQ Tissue, Percutaneous Approach 6. |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | 250.02 ICD-9-CM Diabetes Mellitus without complications 3. E11.9 ICD-10-CM Type 2 Diabetes Mellitus without Complications 4. 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. 3E013VG ICD-10-PCS Intro of Insulin into SubQ Tissue, Percutaneous Approach 6. 1-800-783-3637 US Phone Stanley Steemer (1-800-STEEMER) (go ahead... sing the rest) |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | E11.9 ICD-10-CM Type 2 Diabetes Mellitus without Complications 4. 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. 3E013VG ICD-10-PCS Intro of Insulin into SubQ Tissue, Percutaneous Approach 6. 1-800-783-3637 US Phone Stanley Steemer (1-800-STEEMER) (go ahead... sing the rest) |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. 3E013VG ICD-10-PCS Intro of Insulin into SubQ Tissue, Percutaneous Approach 6. 1-800-783-3637 US Phone Stanley Steemer (1-800-STEEMER) (go ahead... sing the rest) |
99499 | HC CONSULTATIVE PHYSICIAN, PRIMARY PHYSICIAN, PSYCHOLOGISTS, NP | HCPCS | In this
situation, you would add a/an
Level II code. When a neonate or infant is not considered critically ill but still needs intensive observation and other
intensive care services, the initial and continuing intensive care services codes are
99499, unlisted evaluation and management services. What CPT code is assigned to an ED service that has a detailed history and exam with a moderate level
What type of code includes all the words that describe the procedure the code represents? The _______ is the universal health insurance form for submission of outpatient services. J codes in the HCPCS Level II system are used to indicate
medications and dosages. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | The Healthcare Common Procedure Coding System (HCPCS) is a two-tiered system that includes Common Procedure Terminology, at Level I, which is usually referred to as CPT codes. More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. For this reason, both medical billers and medical coders need a solid understanding of how these codes are meant to be used, the kind of understanding that can only be gained through a formal education program of study. |
1741 | Open robotic assisted procedure | ICD | Crosswalk to ICD-10 codes.||HHS/ASPE||CMS, VA, NIH, IHS||January 2015|
|Strategy 5.B: Monitor Progress on the National Plan|
|5.B.1||Designate responsibility for action implementation.||Designate office.||ASPE||Completed|
|5.B.2||Track plan progress.||Track progress on the plan, & incorporate measures into other efforts to monitor population health such as Healthy People 2020.||ASPE||Ongoing|
|5.B.3||Update the National Plan annually.||Release updated National Plan.||ASPE||Ongoing|
Rebok GW, et al. "Ten-Year Effects of the Advanced Cognitive Training for Independent and Vital Elderly Cognitive Training Trial on Cognition and Everyday Functioning in Older Adults." J Am Geriatr Soc, 2014, doi: 10.1111/jgs.12607. http://www.ncbi.nlm.nih.gov/pubmed/24417410. Jonsson T, et al. |
48556 | Removal allograft pancreas | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
48551 | Prep donor pancreas | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
S2065 | SIMULT PANC KIDN TRANS | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
48552 | Prep donor pancreas/venous | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. |
48556 | Removal allograft pancreas | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
48551 | Prep donor pancreas | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
S2065 | SIMULT PANC KIDN TRANS | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
48552 | Prep donor pancreas/venous | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." |
48556 | Removal allograft pancreas | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
48551 | Prep donor pancreas | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
S2065 | SIMULT PANC KIDN TRANS | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
48552 | Prep donor pancreas/venous | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added, table added to Code Reference section
5/2/2002: Type of Service and Place of Service deleted
10/18/2005: Policy section updated; "Absence of HIV infection" deleted; added "HIV positivity is not an absolute contraindication to transplant. Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. |
48556 | Removal allograft pancreas | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
48551 | Prep donor pancreas | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
S2065 | SIMULT PANC KIDN TRANS | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
48552 | Prep donor pancreas/venous | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | Each individual transplant center will determine patient selection criteria for HIV positive patients (7/21/2005)"; Code Reference table updated: CPT codes 48551, 48552, 48556 added; ICD-9 procedure code 00.93 added; HCPCS codes S2065, S2152 added; diagnosis codes 250-250.92, V58.67 added, 250.11, 250.13, 250.21, 250.23, 250.31, 250.41, 250.43, 250.51, 250.61, 250.63, 250.71, 250.73, 250.81, 250.83, 251.0, 251.1, 251.2 deleted. 11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis codes 585.1 - 585.9; description revised
3/13/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
10/23/2006: Policy reviewed, policy section re-written for clarity
2/22/2008: Removed the following policy statement: "Pancreas retransplant after 2 or more prior failed pancreas transplants is considered investigational." No other changes made to policy statements. Code Reference section reviewed. |
90805 | Psytx off 20-30 min w/e&m | HCPCS | The CPT codes were established and are sustained by the American Medical Association. Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). |
38221 | PR DIAGNOSTIC BONE MARROW BIOPSIES | HCPCS | The CPT codes were established and are sustained by the American Medical Association. Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). |
99263 | Follow-up inpatient consult | HCPCS | The CPT codes were established and are sustained by the American Medical Association. Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). |
99261 | Follow-up inpatient consult | HCPCS | The CPT codes were established and are sustained by the American Medical Association. Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). |
99054 | MEDICAL SERVICES-UNUSUAL HRS | CPT | The CPT codes were established and are sustained by the American Medical Association. Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). |
38211 | Tumor cell deplete of harvst | HCPCS | The CPT codes were established and are sustained by the American Medical Association. Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). |
90805 | Psytx off 20-30 min w/e&m | HCPCS | Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. |
38221 | PR DIAGNOSTIC BONE MARROW BIOPSIES | HCPCS | Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. |
99263 | Follow-up inpatient consult | HCPCS | Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. |
99261 | Follow-up inpatient consult | HCPCS | Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. |
99054 | MEDICAL SERVICES-UNUSUAL HRS | CPT | Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. |
38211 | Tumor cell deplete of harvst | HCPCS | Medical coders use CPT to code outpatient procedures and procedures done in physicians' offices. CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. |
90805 | Psytx off 20-30 min w/e&m | HCPCS | CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. |
38221 | PR DIAGNOSTIC BONE MARROW BIOPSIES | HCPCS | CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. |
99263 | Follow-up inpatient consult | HCPCS | CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. |
99261 | Follow-up inpatient consult | HCPCS | CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. |
99054 | MEDICAL SERVICES-UNUSUAL HRS | CPT | CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. |
38211 | Tumor cell deplete of harvst | HCPCS | CPT codes are numeric. Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. |
90805 | Psytx off 20-30 min w/e&m | HCPCS | Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. |
38221 | PR DIAGNOSTIC BONE MARROW BIOPSIES | HCPCS | Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. |
99263 | Follow-up inpatient consult | HCPCS | Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. |
99261 | Follow-up inpatient consult | HCPCS | Changes and additions to the CPT are generally made, at most, four times a year. Here are just a few examples of CPT codes:
- 90805 = outpatient psychotherapy
- 38221 = bone marrow biopsy, trocar or needle
- 38211 = tumor cell depletion
- 99261 - 99263 = follow-up inpatient consultation
- 99054 = services requested on holidays or Sundays
HCPCS (Healthcare Common Procedure Coding System). Medical coders who work with Medicare or Medicaid must become proficient in HCPCS. Maintained by the American Medical Association, the HCPCS has two levels. CPT procedure codes are level one, and HCPCS are level two. |
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