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G6009
Radiation treatment delivery
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
G6013
Radiation treatment delivery
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
G6008
Radiation treatment delivery
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
77412
RAD TRMT DELIVERY, > 1 MEV, COMPL
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
77402
HC RAD TX> 1MEV, SIMPLE
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
G6010
Radiation treatment delivery
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
G6014
Radiation treatment delivery
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
G6004
Radiation treatment delivery
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
61795
Brain surgery using computer
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
G6006
Radiation treatment delivery
HCPCS
Removed deleted CPT code 61795 from the Code Reference section, and added the following ICD-9 codes as covered: 194.6, 198.3, 237.0, 237.3. 12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the...
G6011
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6007
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
77407
HC RADIATION TREATMENT DELIVERY
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6012
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6003
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6005
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6009
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6013
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6008
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
77412
RAD TRMT DELIVERY, > 1 MEV, COMPL
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
77402
HC RAD TX> 1MEV, SIMPLE
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6010
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6014
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6004
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6006
Radiation treatment delivery
HCPCS
12/13/2013: Policy statement updated to state that SRS is considered investigational for uveal melanoma. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6...
G6011
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6007
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
77407
HC RADIATION TREATMENT DELIVERY
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6012
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6003
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6005
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6009
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6013
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6008
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
77412
RAD TRMT DELIVERY, > 1 MEV, COMPL
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
77402
HC RAD TX> 1MEV, SIMPLE
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6010
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6014
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6004
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6006
Radiation treatment delivery
HCPCS
12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 77402, 77407, and 77412. Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S...
G6011
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6007
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6012
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6003
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6005
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6009
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6013
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6008
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6010
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6014
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6004
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
G6006
Radiation treatment delivery
HCPCS
Added the following new 2015 HCPCS codes: G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014. 08/27/2015: Code Reference section updated to add ICD-10 codes. SOURCE(S)Hayes Medical Technology Directory Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10 This may not be a ...
0064T
Spectroscop Eval Expired Gas
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 mus...
83987
Exhaled breath condensate
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 mus...
94799
Other service or procedure on lung
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 mus...
0140T
Exhaled breath condensate ph
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
84999
UNLISTED CHEMISTRY PROCEDURE
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 mus...
0064T
Spectroscop Eval Expired Gas
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T add...
83987
Exhaled breath condensate
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T add...
94799
Other service or procedure on lung
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T add...
0140T
Exhaled breath condensate ph
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 HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T add...
84999
UNLISTED CHEMISTRY PROCEDURE
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T add...
0064T
Spectroscop Eval Expired Gas
HCPCS
POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T added non-covered codes, CPT code 84999 Note: "To report services on or after 1/1/2005, see CPT code 0064T" added 12/22/2005: Collection and...
83987
Exhaled breath condensate
HCPCS
POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T added non-covered codes, CPT code 84999 Note: "To report services on or after 1/1/2005, see CPT code 0064T" added 12/22/2005: Collection and...
94799
Other service or procedure on lung
HCPCS
POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T added non-covered codes, CPT code 84999 Note: "To report services on or after 1/1/2005, see CPT code 0064T" added 12/22/2005: Collection and...
0140T
Exhaled breath condensate ph
CPT
POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T added non-covered codes, CPT code 84999 Note: "To report services on or after 1/1/2005, see CPT code 0064T" added 12/22/2005: Collection and...
84999
UNLISTED CHEMISTRY PROCEDURE
HCPCS
POLICY HISTORY3/25/2004: Approved by Medical Policy Advisory Committee (MPAC) 4/29/2004: Code Reference section completed 3/22/2005: Code Reference section updated, CPT code 0064T added non-covered codes, CPT code 84999 Note: "To report services on or after 1/1/2005, see CPT code 0064T" added 12/22/2005: Collection and...
0140T
Exhaled breath condensate ph
CPT
02/23/2011: Policy reviewed; no changes. 02/24/2012: The first policy statement was revised to change “exhaled or nasal nitric oxide” to “exhaled nitric oxide.” Intent unchanged. Deleted outdated references from the Sources section. Removed deleted CPT codes 0064T and 0140T from the Code Reference section. 04/04/2013: ...
0140T
Exhaled breath condensate ph
CPT
02/24/2012: The first policy statement was revised to change “exhaled or nasal nitric oxide” to “exhaled nitric oxide.” Intent unchanged. Deleted outdated references from the Sources section. Removed deleted CPT codes 0064T and 0140T from the Code Reference section. 04/04/2013: Policy reviewed; no changes. 03/11/2014: ...
0140T
Exhaled breath condensate ph
CPT
Deleted outdated references from the Sources section. Removed deleted CPT codes 0064T and 0140T from the Code Reference section. 04/04/2013: Policy reviewed; no changes. 03/11/2014: Policy reviewed; no changes. 07/20/2015: Policy title changed from "Exhaled Nitric Oxide and Exhaled Breath Condensate Measurements in the...
0140T
Exhaled breath condensate ph
CPT
Removed deleted CPT codes 0064T and 0140T from the Code Reference section. 04/04/2013: Policy reviewed; no changes. 03/11/2014: Policy reviewed; no changes. 07/20/2015: Policy title changed from "Exhaled Nitric Oxide and Exhaled Breath Condensate Measurements in the Diagnosis and Management of Asthma and Other Respirat...
96002
PR DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC
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 mus...
S3900
Surface EMG
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 mus...
96003
PR DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC
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 mus...
96002
PR DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC
HCPCS
POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC) 8/1997: Reviewed by MPAC 6/22/2001: Managed Care Requirements deleted, EMG hyperlink inserted, table added to Code Reference section 2/13/2002: Investigational definition added 5/8/2002: Type of Service and Place of Service deleted 5/23/2002: Co...
S3900
Surface EMG
HCPCS
POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC) 8/1997: Reviewed by MPAC 6/22/2001: Managed Care Requirements deleted, EMG hyperlink inserted, table added to Code Reference section 2/13/2002: Investigational definition added 5/8/2002: Type of Service and Place of Service deleted 5/23/2002: Co...
96003
PR DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC
HCPCS
POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC) 8/1997: Reviewed by MPAC 6/22/2001: Managed Care Requirements deleted, EMG hyperlink inserted, table added to Code Reference section 2/13/2002: Investigational definition added 5/8/2002: Type of Service and Place of Service deleted 5/23/2002: Co...
77385
HC IMRT SIMPLE
HCPCS
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
77418
Radiation tx delivery imrt
HCPCS
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
77387
HC STEREOSCOPIC X-RAY GUIDANCE
HCPCS
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
G6015
Radiation tx delivery imrt
HCPCS
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
0073T
Delivery comp imrt
HCPCS
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
G6015
Radiation tx delivery imrt
HCPCS
New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15. Disclaimer: This medical policy is a guide in evaluating the medical necessity of a particular service or treatment. The Company adopts policies after careful review of publi...
77387
HC STEREOSCOPIC X-RAY GUIDANCE
HCPCS
New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15. Disclaimer: This medical policy is a guide in evaluating the medical necessity of a particular service or treatment. The Company adopts policies after careful review of publi...
88384
Eval molecular probes 11-50
CPT
Neither CancerType ID® nor miRview® (or Rosetta Cancer Origin™) have been submitted to FDA for approval. Gene expression profiling is considered investigational to evaluate the site of origin of a tumor of unknown primary, or to distinguish a primary from a metastatic tumor. Effective in July 2013, there is a specific ...
88384
Eval molecular probes 11-50
CPT
Gene expression profiling is considered investigational to evaluate the site of origin of a tumor of unknown primary, or to distinguish a primary from a metastatic tumor. Effective in July 2013, there is a specific CPT coding for the Pathwork Tissue of Origin test: 81504 - Oncology (tissue of origin), microarray gene e...
81599
Unlisted multianalyte assay with algorithmic analysis
CPT
Gene expression profiling is considered investigational to evaluate the site of origin of a tumor of unknown primary, or to distinguish a primary from a metastatic tumor. Effective in July 2013, there is a specific CPT coding for the Pathwork Tissue of Origin test: 81504 - Oncology (tissue of origin), microarray gene e...
88384
Eval molecular probes 11-50
CPT
Effective in July 2013, there is a specific CPT coding for the Pathwork Tissue of Origin test: 81504 - Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores Prior to July 2013, the preparation ...
81599
Unlisted multianalyte assay with algorithmic analysis
CPT
Effective in July 2013, there is a specific CPT coding for the Pathwork Tissue of Origin test: 81504 - Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores Prior to July 2013, the preparation ...
81599
Unlisted multianalyte assay with algorithmic analysis
CPT
Prior to July 2013, Pathwork Diagnostics stated that they used 84999 (unlisted chemistry procedure). The other tests described below do not have specific CPT codes. If the test result is calculated using an algorithm and reported as a numeric score(s) or as a probability, the unlisted multianalyte assays with algorithm...
81599
Unlisted multianalyte assay with algorithmic analysis
CPT
The other tests described below do not have specific CPT codes. If the test result is calculated using an algorithm and reported as a numeric score(s) or as a probability, the unlisted multianalyte assays with algorithmic analyses code 81599 would be reported. If not, the unlisted molecular pathology code 81479 would b...
90850
nan
CPT
Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. Sep 2011;22 Suppl 6:vi64-68. PMID 21908507 |CPT||81504||Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm re...
90850
nan
CPT
Ann Oncol. Sep 2011;22 Suppl 6:vi64-68. PMID 21908507 |CPT||81504||Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores| |ICD-9 Diagnosis||Investigational for all codes| |ICD-10-CM (effective ...
90850
nan
CPT
Sep 2011;22 Suppl 6:vi64-68. PMID 21908507 |CPT||81504||Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores| |ICD-9 Diagnosis||Investigational for all codes| |ICD-10-CM (effective 10/1/15)||I...
90850
nan
CPT
PMID 21908507 |CPT||81504||Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores| |ICD-9 Diagnosis||Investigational for all codes| |ICD-10-CM (effective 10/1/15)||Investigational for all releva...
87471
HC IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE
HCPCS
CODE ONLY AFTER THE FLU SEASON WAS OVER. There is no specific code for COVID-19 in the U.S. at this time, but one is coming soon. The World Health Organization (WHO) has already added code U07.1 (2019-nCoV acute respiratory disease) to the international ICD-10, and the CDC recently announced(www.cdc.gov) that the same ...
87635
SARS-COV-2 COVID-19 AMP PRB
HCPCS
CODE ONLY AFTER THE FLU SEASON WAS OVER. There is no specific code for COVID-19 in the U.S. at this time, but one is coming soon. The World Health Organization (WHO) has already added code U07.1 (2019-nCoV acute respiratory disease) to the international ICD-10, and the CDC recently announced(www.cdc.gov) that the same ...
87471
HC IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE
HCPCS
There is no specific code for COVID-19 in the U.S. at this time, but one is coming soon. The World Health Organization (WHO) has already added code U07.1 (2019-nCoV acute respiratory disease) to the international ICD-10, and the CDC recently announced(www.cdc.gov) that the same code would be added to the U.S. ICD-10-CM...
87635
SARS-COV-2 COVID-19 AMP PRB
HCPCS
There is no specific code for COVID-19 in the U.S. at this time, but one is coming soon. The World Health Organization (WHO) has already added code U07.1 (2019-nCoV acute respiratory disease) to the international ICD-10, and the CDC recently announced(www.cdc.gov) that the same code would be added to the U.S. ICD-10-CM...
87471
HC IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE
HCPCS
The World Health Organization (WHO) has already added code U07.1 (2019-nCoV acute respiratory disease) to the international ICD-10, and the CDC recently announced(www.cdc.gov) that the same code would be added to the U.S. ICD-10-CM list effective April 1. Starting on that day, U07.1 should be used to report a patient w...