code stringlengths 4 12 | description stringlengths 2 264 | codetype stringclasses 8 values | context stringlengths 160 15.5k |
|---|---|---|---|
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 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. |
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 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. |
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 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. |
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 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. |
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 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. |
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 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. |
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 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. |
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 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. |
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 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. |
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 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. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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, 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 comprehensive list of procedure codes applicable to this policy. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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)Hayes Medical Technology Directory
Blue Cross Blue Shield Association policies # 6.01.10 and # 8.01.10
This may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. Coding for SRS typically consists of a series of CPT codes describing the individual steps required:
The codes used for treatment delivery will depend on the energy source used. |
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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 Measurement of Exhaled Breath Condensate and coding 0140T added to policy
1/3/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
1/3/2007: Policy reviewed, no changes
12/17/2008: Policy reviewed, no changes
05/28/2010: Title updated with "Exhaled Breath Condensate"; Description section updated; Policy Statement section - existing policy statement was divided into two statements: one for exhaled nitric oxide and the other for exhaled breath condensate - both remain investigational; FEP verbiage was added to the Policy Exceptions section; and Code Reference section was updated to add new CPT Code 83987 and CPT Code 94799 to the Non-Covered Codes Table. 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. |
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: Policy reviewed; no changes. |
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: Policy reviewed; no changes. |
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 Diagnosis and Management of Asthma and Other Respiratory Disorders" to "Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders." |
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 Respiratory Disorders" to "Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders." Policy description revised and updated regarding devices. |
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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: Code Reference section completed, CPT code 96002 added, HCPCS S3900 added
6/23/2004: Policy reviewed
8/15/2005: Code Reference section updated, CPT code 96003 added
4/18/2006: Policy updated
2/14/2008: Policy reviewed, no changes
04/16/2010: "To Evaluate and Monitor Back Pain" added to the policy title. Policy description updated. The verbiage “and is not eligible for coverage” deleted from the policy statement; intent unchanged. |
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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: Code Reference section completed, CPT code 96002 added, HCPCS S3900 added
6/23/2004: Policy reviewed
8/15/2005: Code Reference section updated, CPT code 96003 added
4/18/2006: Policy updated
2/14/2008: Policy reviewed, no changes
04/16/2010: "To Evaluate and Monitor Back Pain" added to the policy title. Policy description updated. The verbiage “and is not eligible for coverage” deleted from the policy statement; intent unchanged. |
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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: Code Reference section completed, CPT code 96002 added, HCPCS S3900 added
6/23/2004: Policy reviewed
8/15/2005: Code Reference section updated, CPT code 96003 added
4/18/2006: Policy updated
2/14/2008: Policy reviewed, no changes
04/16/2010: "To Evaluate and Monitor Back Pain" added to the policy title. Policy description updated. The verbiage “and is not eligible for coverage” deleted from the policy statement; intent unchanged. |
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: Code Reference section completed, CPT code 96002 added, HCPCS S3900 added
6/23/2004: Policy reviewed
8/15/2005: Code Reference section updated, CPT code 96003 added
4/18/2006: Policy updated
2/14/2008: Policy reviewed, no changes
04/16/2010: "To Evaluate and Monitor Back Pain" added to the policy title. Policy description updated. The verbiage “and is not eligible for coverage” deleted from the policy statement; intent unchanged. FEP verbiage added to the Policy Exceptions section. Deleted outdated references from Sources section. |
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: Code Reference section completed, CPT code 96002 added, HCPCS S3900 added
6/23/2004: Policy reviewed
8/15/2005: Code Reference section updated, CPT code 96003 added
4/18/2006: Policy updated
2/14/2008: Policy reviewed, no changes
04/16/2010: "To Evaluate and Monitor Back Pain" added to the policy title. Policy description updated. The verbiage “and is not eligible for coverage” deleted from the policy statement; intent unchanged. FEP verbiage added to the Policy Exceptions section. Deleted outdated references from Sources section. |
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: Code Reference section completed, CPT code 96002 added, HCPCS S3900 added
6/23/2004: Policy reviewed
8/15/2005: Code Reference section updated, CPT code 96003 added
4/18/2006: Policy updated
2/14/2008: Policy reviewed, no changes
04/16/2010: "To Evaluate and Monitor Back Pain" added to the policy title. Policy description updated. The verbiage “and is not eligible for coverage” deleted from the policy statement; intent unchanged. FEP verbiage added to the Policy Exceptions section. Deleted outdated references from Sources section. |
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 published peer-reviewed scientific literature, national guidelines and local standards of practice. |
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 published peer-reviewed scientific literature, national guidelines and local standards of practice. |
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 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 of the probes might have been coded using a combination of the molecular diagnostic codes 83890-83913 and the analysis of the probes might have been coded using array-based evaluation of multiple molecular probes codes 88384-88386 based on the number of probes analyzed. 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. |
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 expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores
Prior to July 2013, the preparation of the probes might have been coded using a combination of the molecular diagnostic codes 83890-83913 and the analysis of the probes might have been coded using array-based evaluation of multiple molecular probes codes 88384-88386 based on the number of probes analyzed. 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 algorithmic analyses code 81599 would be reported. |
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 expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores
Prior to July 2013, the preparation of the probes might have been coded using a combination of the molecular diagnostic codes 83890-83913 and the analysis of the probes might have been coded using array-based evaluation of multiple molecular probes codes 88384-88386 based on the number of probes analyzed. 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 algorithmic analyses code 81599 would be reported. |
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 of the probes might have been coded using a combination of the molecular diagnostic codes 83890-83913 and the analysis of the probes might have been coded using array-based evaluation of multiple molecular probes codes 88384-88386 based on the number of probes analyzed. 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 algorithmic analyses code 81599 would be reported. If not, the unlisted molecular pathology code 81479 would be reported. |
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 of the probes might have been coded using a combination of the molecular diagnostic codes 83890-83913 and the analysis of the probes might have been coded using array-based evaluation of multiple molecular probes codes 88384-88386 based on the number of probes analyzed. 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 algorithmic analyses code 81599 would be reported. If not, the unlisted molecular pathology code 81479 would be reported. |
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 algorithmic analyses code 81599 would be reported. If not, the unlisted molecular pathology code 81479 would be reported. BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all FDA-approved devices may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity. |
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 be reported. BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all FDA-approved devices may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity. This policy was created in December 2008 and has been updated annually. |
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 reported as tissue similarity scores|
|ICD-9 Diagnosis||Investigational for all codes|
|ICD-10-CM (effective 10/1/15)||Investigational for all relevant diagnoses|
|C79.9||Secondary malignant neoplasm of unspecified site|
|C80.0||Disseminated malignant neoplasm, unspecified|
|C80.1||Malignant (primary) neoplasm, unspecified|
|ICD-10-PCS (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. |
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 10/1/15)||Investigational for all relevant diagnoses|
|C79.9||Secondary malignant neoplasm of unspecified site|
|C80.0||Disseminated malignant neoplasm, unspecified|
|C80.1||Malignant (primary) neoplasm, unspecified|
|ICD-10-PCS (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. There are no ICD procedure codes for laboratory tests.|
|Type of Service||Pathology/Laboratory|
|Place of Service||Laboratory/Reference Laboratory|
Pathwork Tissue of Unknown Origin
Add to Medicine section
|12/03/09||Replace policy||Policy updated with literature search; reference 12 added, reference 13 updated. |
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)||Investigational for all relevant diagnoses|
|C79.9||Secondary malignant neoplasm of unspecified site|
|C80.0||Disseminated malignant neoplasm, unspecified|
|C80.1||Malignant (primary) neoplasm, unspecified|
|ICD-10-PCS (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. There are no ICD procedure codes for laboratory tests.|
|Type of Service||Pathology/Laboratory|
|Place of Service||Laboratory/Reference Laboratory|
Pathwork Tissue of Unknown Origin
Add to Medicine section
|12/03/09||Replace policy||Policy updated with literature search; reference 12 added, reference 13 updated. No change to policy statement|
|11/11/10||Replace policy||Policy updated with literature search; reference 12 added, reference 1 and 13 updated; new test for formalin-fixed paraffin-embedded (FFPE) specimens added as investigational, no change to existing policy statement|
|11/10/11||Replace policy||Policy updated with literature search; references 11, 12 and 14 added. |
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 relevant diagnoses|
|C79.9||Secondary malignant neoplasm of unspecified site|
|C80.0||Disseminated malignant neoplasm, unspecified|
|C80.1||Malignant (primary) neoplasm, unspecified|
|ICD-10-PCS (effective 10/1/15)||Not applicable. ICD-10-PCS codes are only used for inpatient services. There are no ICD procedure codes for laboratory tests.|
|Type of Service||Pathology/Laboratory|
|Place of Service||Laboratory/Reference Laboratory|
Pathwork Tissue of Unknown Origin
Add to Medicine section
|12/03/09||Replace policy||Policy updated with literature search; reference 12 added, reference 13 updated. No change to policy statement|
|11/11/10||Replace policy||Policy updated with literature search; reference 12 added, reference 1 and 13 updated; new test for formalin-fixed paraffin-embedded (FFPE) specimens added as investigational, no change to existing policy statement|
|11/10/11||Replace policy||Policy updated with literature search; references 11, 12 and 14 added. No change to policy statement.|
|11/08/12||Replace policy||Policy updated with literature search; references 14- 21 added. |
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 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 who has tested positive for COVID-19. Until then, the CDC has published the following interim guidance on coding for this condition: For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”
Diagnostic code “87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplified probe technique” 87635 is under parent code 87471. https://www.aapc.com/blog/49987-new-cpt-code-for-reporting-covid-19-test/ There are also two new HCPCS Level II testing codes for reporting Medicare beneficiaries being tested for COVID-19,
Question: Should CPT code 87635, a HCPCS Level II code, or both be reported if the test for COVID-19 is performed? |
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 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 who has tested positive for COVID-19. Until then, the CDC has published the following interim guidance on coding for this condition: For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”
Diagnostic code “87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplified probe technique” 87635 is under parent code 87471. https://www.aapc.com/blog/49987-new-cpt-code-for-reporting-covid-19-test/ There are also two new HCPCS Level II testing codes for reporting Medicare beneficiaries being tested for COVID-19,
Question: Should CPT code 87635, a HCPCS Level II code, or both be reported if the test for COVID-19 is performed? |
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 list effective April 1. Starting on that day, U07.1 should be used to report a patient who has tested positive for COVID-19. Until then, the CDC has published the following interim guidance on coding for this condition: For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”
Diagnostic code “87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplified probe technique” 87635 is under parent code 87471. https://www.aapc.com/blog/49987-new-cpt-code-for-reporting-covid-19-test/ There are also two new HCPCS Level II testing codes for reporting Medicare beneficiaries being tested for COVID-19,
Question: Should CPT code 87635, a HCPCS Level II code, or both be reported if the test for COVID-19 is performed? Answer: The appropriate code to be reported is dependent upon the payer to which the claim is being submitted. |
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 list effective April 1. Starting on that day, U07.1 should be used to report a patient who has tested positive for COVID-19. Until then, the CDC has published the following interim guidance on coding for this condition: For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”
Diagnostic code “87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplified probe technique” 87635 is under parent code 87471. https://www.aapc.com/blog/49987-new-cpt-code-for-reporting-covid-19-test/ There are also two new HCPCS Level II testing codes for reporting Medicare beneficiaries being tested for COVID-19,
Question: Should CPT code 87635, a HCPCS Level II code, or both be reported if the test for COVID-19 is performed? Answer: The appropriate code to be reported is dependent upon the payer to which the claim is being submitted. |
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 who has tested positive for COVID-19. Until then, the CDC has published the following interim guidance on coding for this condition: For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”
Diagnostic code “87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplified probe technique” 87635 is under parent code 87471. https://www.aapc.com/blog/49987-new-cpt-code-for-reporting-covid-19-test/ There are also two new HCPCS Level II testing codes for reporting Medicare beneficiaries being tested for COVID-19,
Question: Should CPT code 87635, a HCPCS Level II code, or both be reported if the test for COVID-19 is performed? Answer: The appropriate code to be reported is dependent upon the payer to which the claim is being submitted. If the claim is submitted to a payer that requires CPT codes, then code 87635 should be reported. |
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