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28285
Repair of hammertoe
HCPCS
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
L2300
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
HCPCS
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
L2280
Molded inner boot
HCPCS
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
L2768
Orthotic side bar disconnect device, per bar
HCPCS
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
28300
PR OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
HCPCS
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
28309
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
HCPCS
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
L1960
HC SUPPLY ANKLE FOOT ORTHOSIS POSTERIOR SOLID ANKLE CUSTOM - L1960
HCPCS
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
28285
Repair of hammertoe
HCPCS
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
L2300
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
HCPCS
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
L2280
Molded inner boot
HCPCS
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
L2768
Orthotic side bar disconnect device, per bar
HCPCS
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
28300
PR OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
HCPCS
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
L1960
HC SUPPLY ANKLE FOOT ORTHOSIS POSTERIOR SOLID ANKLE CUSTOM - L1960
HCPCS
DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
L2300
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
HCPCS
DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
L2280
Molded inner boot
HCPCS
DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
L2768
Orthotic side bar disconnect device, per bar
HCPCS
DME Supply Coding For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician: L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated L2280 Addition to lower extremity, molded inner boot L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable L2768 Orthotic side bar disconnect device, per bar Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
1744
Endoscopic robotic assisted procedure
ICD
Epub 2015/07/16. pmid:26174442. - 26. Koopman B, Zuccon G, Nguyen A, Bergheim A, Grayson N. Automatic ICD-10 classification of cancers from free-text death certificates. Int J Med Inform.
1744
Endoscopic robotic assisted procedure
ICD
pmid:26174442. - 26. Koopman B, Zuccon G, Nguyen A, Bergheim A, Grayson N. Automatic ICD-10 classification of cancers from free-text death certificates. Int J Med Inform. 2015;84(11):956–65.
G0296
Visit to determ ldct elig
HCPCS
Coding for Lung Cancer Preventative Services Medicare covers annual lung cancer screening with LDCT and counseling to discuss the need for lung cancer screening the first year. There is no deductible or coinsurance/copayment for these services. Medicare covers lung cancer screening services for beneficiaries who meet all of the following conditions: - Aged 55 through 77 - Asymptomatic (no signs or symptoms of lung cancer) - Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes) - Current smoker or one who has quit smoking within the last 15 years - Receive a written order for lung cancer screening with LDCT When filing claims for these screening tests, use the following codes to ensure proper billing and reimbursement. HCPCS Level II Codes G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct). Service is for eligibility determination and shared decision making.
G0296
Visit to determ ldct elig
HCPCS
There is no deductible or coinsurance/copayment for these services. Medicare covers lung cancer screening services for beneficiaries who meet all of the following conditions: - Aged 55 through 77 - Asymptomatic (no signs or symptoms of lung cancer) - Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes) - Current smoker or one who has quit smoking within the last 15 years - Receive a written order for lung cancer screening with LDCT When filing claims for these screening tests, use the following codes to ensure proper billing and reimbursement. HCPCS Level II Codes G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct). Service is for eligibility determination and shared decision making. G0297 Low dose ct scan (ldct) for lung cancer screening Bill these services with the ICD-10-CM code Z87.891 Personal history of tobacco use/personal history of nicotine dependence.
G0297
LOW-DOSE CT SCAN (LDCT) FOR LUNG CANCER SCREENING
HCPCS
There is no deductible or coinsurance/copayment for these services. Medicare covers lung cancer screening services for beneficiaries who meet all of the following conditions: - Aged 55 through 77 - Asymptomatic (no signs or symptoms of lung cancer) - Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes) - Current smoker or one who has quit smoking within the last 15 years - Receive a written order for lung cancer screening with LDCT When filing claims for these screening tests, use the following codes to ensure proper billing and reimbursement. HCPCS Level II Codes G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct). Service is for eligibility determination and shared decision making. G0297 Low dose ct scan (ldct) for lung cancer screening Bill these services with the ICD-10-CM code Z87.891 Personal history of tobacco use/personal history of nicotine dependence.
G0296
Visit to determ ldct elig
HCPCS
HCPCS Level II Codes G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct). Service is for eligibility determination and shared decision making. G0297 Low dose ct scan (ldct) for lung cancer screening Bill these services with the ICD-10-CM code Z87.891 Personal history of tobacco use/personal history of nicotine dependence. Additional ICD-10-CM codes may apply, including F17.210, F17.211, F17.213, F17.218, F17.219. For additional information regarding lung cancer screening with LDCT, see NCD 210.14 and MLN article MM9246 - Expedited Release of 4 New Codes for COVID-19 Testing - September 8, 2020 - Rules Are Changing: The Impending Transition to ICD-11 - September 1, 2020 - Go Blue for Prostate Cancer Awareness Month - September 1, 2020
G0297
LOW-DOSE CT SCAN (LDCT) FOR LUNG CANCER SCREENING
HCPCS
HCPCS Level II Codes G0296 Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct). Service is for eligibility determination and shared decision making. G0297 Low dose ct scan (ldct) for lung cancer screening Bill these services with the ICD-10-CM code Z87.891 Personal history of tobacco use/personal history of nicotine dependence. Additional ICD-10-CM codes may apply, including F17.210, F17.211, F17.213, F17.218, F17.219. For additional information regarding lung cancer screening with LDCT, see NCD 210.14 and MLN article MM9246 - Expedited Release of 4 New Codes for COVID-19 Testing - September 8, 2020 - Rules Are Changing: The Impending Transition to ICD-11 - September 1, 2020 - Go Blue for Prostate Cancer Awareness Month - September 1, 2020
2002
CARDIAC STRUCTURAL & VALVULAR DISORDERS
APR-DRG
Retrospective case-control study. Administrative claims data from 45 academic medical centers. A total of 10,857 patients who developed health care-associated CDI and were discharged between April 1, 2002, and March 31, 2007 (cases); each case patient was matched by hospital, age, quarter and year of hospital discharge, and diagnosis related group to at least one control patient who did not develop health care-associated CDI (19,214 controls). Patients with health care-associated CDI were identified by using a previously validated method combining the International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI with specific CDI drug therapy (oral or intravenous metronidazole, or oral vancomycin). Costs were determined from charges by using standardized cost:charges ratios and were adjusted for age, All Patient Refined-Diagnosis Related Group (APR-DRG) severity of illness level, race, and sex with use of multivariable linear regression.
2002
CARDIAC STRUCTURAL & VALVULAR DISORDERS
APR-DRG
A total of 10,857 patients who developed health care-associated CDI and were discharged between April 1, 2002, and March 31, 2007 (cases); each case patient was matched by hospital, age, quarter and year of hospital discharge, and diagnosis related group to at least one control patient who did not develop health care-associated CDI (19,214 controls). Patients with health care-associated CDI were identified by using a previously validated method combining the International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI with specific CDI drug therapy (oral or intravenous metronidazole, or oral vancomycin). Costs were determined from charges by using standardized cost:charges ratios and were adjusted for age, All Patient Refined-Diagnosis Related Group (APR-DRG) severity of illness level, race, and sex with use of multivariable linear regression. The adjusted mean cost for cases was significantly higher than that for controls ($55,769 vs $28,609), and adjusted mean length of stay was twice as long (21.1 vs 10.0 days). The interaction between CDI and APR-DRG severity of illness level was significant; the effect of CDI on costs and length of stay decreased as severity of illness increased.
00216
ANESTH HEAD VESSEL SURGERY
CPT
For this procedure, we’d code 35471 for “transluminal balloon angioplasty, percutaneous; renal or other visceral artery,” and we’d add the modifier -66 for “surgical team.” So we’d end up with 35471-66. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/ Physical Status Modifier (For Anesthesia) Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are: - P1 – a normal, healthy patient - P2 – a patient with mild systemic disease - P3 – a patient with severe systemic disease - P4 – a patient with severe systemic disease that is a constant threat to life - P5 – a moribund patient who is not expected to survive without the operation - P6 – a declared brain-dead patient whose organs are being removed for donor purposes These are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1.
00216
ANESTH HEAD VESSEL SURGERY
CPT
These codes are: - P1 – a normal, healthy patient - P2 – a patient with mild systemic disease - P3 – a patient with severe systemic disease - P4 – a patient with severe systemic disease that is a constant threat to life - P5 – a moribund patient who is not expected to survive without the operation - P6 – a declared brain-dead patient whose organs are being removed for donor purposes These are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/ Complete List of CPT Modifiers 2015 To view a complete list of CPT Modifiers, you can check out these resources below: - 2014 Level I and Level II CPT Modifiers - CPT and HCPCS Level II Modifiers - 2012 Coding Modifiers Table As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates.
00216
ANESTH HEAD VESSEL SURGERY
CPT
Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/ Complete List of CPT Modifiers 2015 To view a complete list of CPT Modifiers, you can check out these resources below: - 2014 Level I and Level II CPT Modifiers - CPT and HCPCS Level II Modifiers - 2012 Coding Modifiers Table As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. In this webinar, you will learn about the 143 deleted codes and why they were given the boot.
00216
ANESTH HEAD VESSEL SURGERY
CPT
The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/ Complete List of CPT Modifiers 2015 To view a complete list of CPT Modifiers, you can check out these resources below: - 2014 Level I and Level II CPT Modifiers - CPT and HCPCS Level II Modifiers - 2012 Coding Modifiers Table As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we’ve done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. In this webinar, you will learn about the 143 deleted codes and why they were given the boot. You will also learn the 264 New codes and when to use them and if they replaced older codes and more.
1999
ANESTHESIOLOGY GROUP
CPT
Stemming from the French Bertillon classification in the late 1800s, the WHO took over ICD in 1946. The three-volume ICD-9 CM (ICD-Version 9 Clinical Modifications) was introduced in 1979 and is also the HIPAA transaction code set. Physicians use Volumes 1 and 2 of ICD-9 CM for diagnostic codes and Current Procedural Terminology (CPT) codes for their procedures. Volume 3 of ICD-9 CM is used by hospitals for procedure codes. ICD-10, ICD-10 CM and ICD-10 PCS ICD-Version 10 has been used for morbidity and mortality statistics worldwide since 1994 and in the U.S. since 1999.
1999
ANESTHESIOLOGY GROUP
CPT
The three-volume ICD-9 CM (ICD-Version 9 Clinical Modifications) was introduced in 1979 and is also the HIPAA transaction code set. Physicians use Volumes 1 and 2 of ICD-9 CM for diagnostic codes and Current Procedural Terminology (CPT) codes for their procedures. Volume 3 of ICD-9 CM is used by hospitals for procedure codes. ICD-10, ICD-10 CM and ICD-10 PCS ICD-Version 10 has been used for morbidity and mortality statistics worldwide since 1994 and in the U.S. since 1999. ICD-10 CM, introduced in 2002, replaces ICD-9 CM with a final adoption deadline of October 1, 2013, mandated by Health and Human Services (HHS).
1999
ANESTHESIOLOGY GROUP
CPT
Physicians use Volumes 1 and 2 of ICD-9 CM for diagnostic codes and Current Procedural Terminology (CPT) codes for their procedures. Volume 3 of ICD-9 CM is used by hospitals for procedure codes. ICD-10, ICD-10 CM and ICD-10 PCS ICD-Version 10 has been used for morbidity and mortality statistics worldwide since 1994 and in the U.S. since 1999. ICD-10 CM, introduced in 2002, replaces ICD-9 CM with a final adoption deadline of October 1, 2013, mandated by Health and Human Services (HHS). ICD-10 CM includes 68,000 diagnostic codes, five times more than ICD-9 CM.
24640
PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
HCPCS
Treatment: Mild but constant traction of the arm with supranational and then probation with flex ion and extension should return the radial head to its proper anatomical location. To see how this works, click on the following link to watch a You Tube video showing a toddler having her radial head reduced. To see this technique demonstrated, click on the YouTube link: http://www.youtube.com/watch?v=tJb5rGOFiTY CPT Coding: 24640 Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. This article is available for publishing on websites, blogs, and newsletters.
24640
PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ
HCPCS
To see how this works, click on the following link to watch a You Tube video showing a toddler having her radial head reduced. To see this technique demonstrated, click on the YouTube link: http://www.youtube.com/watch?v=tJb5rGOFiTY CPT Coding: 24640 Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding. This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active.
L0100
CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL
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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
97799
Unlisted physcl med/rehab px
HCPCS
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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
97703
PROSTHETIC CHECKOUT
CPT
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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
L0110
CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED
HCPCS
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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
S1040
Cranial remolding orthosis
HCPCS
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 HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational."
L0100
CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
97799
Unlisted physcl med/rehab px
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
97703
PROSTHETIC CHECKOUT
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
L0110
CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
S1040
Cranial remolding orthosis
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses.
L0100
CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL
HCPCS
POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
97799
Unlisted physcl med/rehab px
HCPCS
POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
97703
PROSTHETIC CHECKOUT
CPT
POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
L0110
CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED
HCPCS
POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
S1040
Cranial remolding orthosis
HCPCS
POLICY HISTORY11/1997: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, CPT code 97799, 97703, ICD-9 procedure code 93.29, ICD-9 diagnosis code 754.0, HCPCS L0100, L0110 8/2000: Reviewed by Medical Policy Advisory Committee (MPAC), investigational status maintained. 10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery.
L0100
CRANIL ORTHOSIS W/WO SOFT INTERFCE MOLDED PT MDL
HCPCS
10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged.
S1040
Cranial remolding orthosis
HCPCS
10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged.
97799
Unlisted physcl med/rehab px
HCPCS
10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged.
L0110
CRANIAL ORTHOSIS W/WO SOFT-INTERFACE NON-MOLDED
HCPCS
10/17/2001: Sources and Code Reference sections updated 2/11/2002: Investigational definition added 4/26/2002: Type of Service and Place of Service deleted 9/20/2002: Policy statement revised 10/11/2002: HCPCS S1040 added 5/20/2004: Code Reference section updated, CPT code 97799 deleted, HCPCS L0100, L0110 description revised 6/24/2004: Policy reviewed, Description section revised to be consistent with BCBSA policy # 1.01.11 8/5/2005: Code Reference section updated, ICD-9 procedure code 93.29 deleted 3/22/2006: Coding updated. CPT4 2006 revisions added to policy 3/28/2006: Policy reviewed, no changes 12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 4/24/2007: Policy reviewed, no changes 12/22/2008: Policy reviewed, the following removed from the policy statement, "As an adjunctive postsurgical therapy for synostotic plagiocephaly, dynamic orthotic cranioplasty is considered investigational." 06/23/2010: Policy title changed from “Adjustable Banding as a Treatment of Plagiocephaly” to “Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses.” Policy description updated regarding treatment approaches and craniosynostoses. Added policy statements on craniosynostoses, which is considered medically necessary following cranial vault remodeling surgery. Reworded policy statement regarding nonsynostotic plagiocephaly/ brachycephaly; intent unchanged.
1512
New Technology - Level 12
APC
ICD-9 Look up and Description ICD-10 Look up, Code and Description 300.00 – anxiety state, unspecified Look up as; Anxiety – includes, neurosis, reaction, state (Neurotic) and atypical anxiety disorder Look up as; Anxiety – F41.9 – anxiety disorder, unspecified 300.01 – Panic disorder without agoraphobia Look up as; Anxiety, panic type, includes panic attack and panic state Look up as; Anxiety, panic type – F41.0 300.02 – anxiety, generalized Look up as; Anxiety - generalized Look up as; Anxiety generalized – F41.1 300.09 - other Look up as; Anxiety, if nothing specific use this code Look up as; Anxiety and if not classified use – F41.3 It is imperative that the provider document exactly what the medical history, examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study. This will also allow the coding staff to select the most appropriate ICD-10 diagnosis code for reporting on the claim for reimbursement. - ICD-10-CM, 2016 Complete Official Code Set, Chapter 5, Page 533, Mental, Behavioral and Neurodevelpmental Disorders (F01-F99), AAPC, Optum360 2015. - ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Volume 1, Chapter 5, Page 86, Mental, Behavioral and Neurodevelopmental Disorders (290-319), Editor – Anita C. Hart, Optuminsight August 2013. - Merck Manual, Section 15 - Psychiatric Disorders, Chapter 187 – Anxiety Disorders, Page 1512 - 1516, Gary Zelko, Publisher, June 1999.
1516
New Technology - Level 16
APC
ICD-9 Look up and Description ICD-10 Look up, Code and Description 300.00 – anxiety state, unspecified Look up as; Anxiety – includes, neurosis, reaction, state (Neurotic) and atypical anxiety disorder Look up as; Anxiety – F41.9 – anxiety disorder, unspecified 300.01 – Panic disorder without agoraphobia Look up as; Anxiety, panic type, includes panic attack and panic state Look up as; Anxiety, panic type – F41.0 300.02 – anxiety, generalized Look up as; Anxiety - generalized Look up as; Anxiety generalized – F41.1 300.09 - other Look up as; Anxiety, if nothing specific use this code Look up as; Anxiety and if not classified use – F41.3 It is imperative that the provider document exactly what the medical history, examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study. This will also allow the coding staff to select the most appropriate ICD-10 diagnosis code for reporting on the claim for reimbursement. - ICD-10-CM, 2016 Complete Official Code Set, Chapter 5, Page 533, Mental, Behavioral and Neurodevelpmental Disorders (F01-F99), AAPC, Optum360 2015. - ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Volume 1, Chapter 5, Page 86, Mental, Behavioral and Neurodevelopmental Disorders (290-319), Editor – Anita C. Hart, Optuminsight August 2013. - Merck Manual, Section 15 - Psychiatric Disorders, Chapter 187 – Anxiety Disorders, Page 1512 - 1516, Gary Zelko, Publisher, June 1999.
1512
New Technology - Level 12
APC
This will also allow the coding staff to select the most appropriate ICD-10 diagnosis code for reporting on the claim for reimbursement. - ICD-10-CM, 2016 Complete Official Code Set, Chapter 5, Page 533, Mental, Behavioral and Neurodevelpmental Disorders (F01-F99), AAPC, Optum360 2015. - ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Volume 1, Chapter 5, Page 86, Mental, Behavioral and Neurodevelopmental Disorders (290-319), Editor – Anita C. Hart, Optuminsight August 2013. - Merck Manual, Section 15 - Psychiatric Disorders, Chapter 187 – Anxiety Disorders, Page 1512 - 1516, Gary Zelko, Publisher, June 1999.
1516
New Technology - Level 16
APC
This will also allow the coding staff to select the most appropriate ICD-10 diagnosis code for reporting on the claim for reimbursement. - ICD-10-CM, 2016 Complete Official Code Set, Chapter 5, Page 533, Mental, Behavioral and Neurodevelpmental Disorders (F01-F99), AAPC, Optum360 2015. - ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Volume 1, Chapter 5, Page 86, Mental, Behavioral and Neurodevelopmental Disorders (290-319), Editor – Anita C. Hart, Optuminsight August 2013. - Merck Manual, Section 15 - Psychiatric Disorders, Chapter 187 – Anxiety Disorders, Page 1512 - 1516, Gary Zelko, Publisher, June 1999.
1512
New Technology - Level 12
APC
- ICD-10-CM, 2016 Complete Official Code Set, Chapter 5, Page 533, Mental, Behavioral and Neurodevelpmental Disorders (F01-F99), AAPC, Optum360 2015. - ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Volume 1, Chapter 5, Page 86, Mental, Behavioral and Neurodevelopmental Disorders (290-319), Editor – Anita C. Hart, Optuminsight August 2013. - Merck Manual, Section 15 - Psychiatric Disorders, Chapter 187 – Anxiety Disorders, Page 1512 - 1516, Gary Zelko, Publisher, June 1999.
1516
New Technology - Level 16
APC
- ICD-10-CM, 2016 Complete Official Code Set, Chapter 5, Page 533, Mental, Behavioral and Neurodevelpmental Disorders (F01-F99), AAPC, Optum360 2015. - ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Volume 1, Chapter 5, Page 86, Mental, Behavioral and Neurodevelopmental Disorders (290-319), Editor – Anita C. Hart, Optuminsight August 2013. - Merck Manual, Section 15 - Psychiatric Disorders, Chapter 187 – Anxiety Disorders, Page 1512 - 1516, Gary Zelko, Publisher, June 1999.
L8606
SYRINGE DURASPHERE EXP 1ML
HCPCS
Added bulking agent HCPCS codes L8603, L8604, and L8606. 12/30/2010: Policy reviewed; no changes. 12/01/2011: Policy reviewed; no changes. 12/13/2013: Policy reviewed; no changes to policy statement. Deleted duplicated ureter as a contraindication in the policy guidelines.
L8604
SYRINGE DEFLUX INJ PREFILL 1ML GLASS
HCPCS
Added bulking agent HCPCS codes L8603, L8604, and L8606. 12/30/2010: Policy reviewed; no changes. 12/01/2011: Policy reviewed; no changes. 12/13/2013: Policy reviewed; no changes to policy statement. Deleted duplicated ureter as a contraindication in the policy guidelines.
L8603
Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies
HCPCS
Added bulking agent HCPCS codes L8603, L8604, and L8606. 12/30/2010: Policy reviewed; no changes. 12/01/2011: Policy reviewed; no changes. 12/13/2013: Policy reviewed; no changes to policy statement. Deleted duplicated ureter as a contraindication in the policy guidelines.
1999
ANESTHESIOLOGY GROUP
CPT
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated.
S2120
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated.
36511
PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated.
36513
PR THERAPEUTIC APHERESIS PLATELETS
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated.
36512
PR THERAPEUTIC APHERESIS RED BLOOD CELLS
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated.
36521
USE 36516
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated.
36520
SEE 36511-36512
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated.
1999
ANESTHESIOLOGY GROUP
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
S2120
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
36511
PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
36513
PR THERAPEUTIC APHERESIS PLATELETS
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
36512
PR THERAPEUTIC APHERESIS RED BLOOD CELLS
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
36521
USE 36516
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
36520
SEE 36511-36512
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
1999
ANESTHESIOLOGY GROUP
CPT
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
S2120
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
36511
PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
36513
PR THERAPEUTIC APHERESIS PLATELETS
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
36512
PR THERAPEUTIC APHERESIS RED BLOOD CELLS
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
36521
USE 36516
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
36520
SEE 36511-36512
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis 2/2000: Interim revisions approved by MPAC 4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection 8/2001: Reviewed by MPAC 2/13/2002: Investigational definition added 5/2/2002: Type of Service and Place of Service deleted 10/4/2002: ICD-9 procedure code 99.76 added 3/5/2003: Code Reference section updated 7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated 3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added 10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added 11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31 3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy 7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC) 8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table 5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
36522
PR PHOTOPHERESIS EXTRACORPOREAL
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
S2120
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
86960
HC VOL REDUC BLD/PRD EA UN
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
36516
PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
36515
Apheresis adsorp/reinfuse
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
36522
PR PHOTOPHERESIS EXTRACORPOREAL
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
S2120
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
86960
HC VOL REDUC BLD/PRD EA UN
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
36516
PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
36515
Apheresis adsorp/reinfuse
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added 9/11/2008: Annual ICD-9 updates applied 06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
1742
Laparoscopic robotic assisted procedure
ICD
Different manufacturers offer either one or the other and sometimes both. CS1 maint: Uses authors parameter (link) For other uses, seeBlack Light (disambiguation). Operations/surgeriesand other procedures of theskinandsubcutaneous tissueICD-9-CM V386,ICD-10-PCS 0H) (7): 10534.PMID17427621Archivedfrom the original on 2008-08-28. CS1 maint: Uses authors parameter (link) High powermercury vaporblack light lamps are made in power ratings of 100 to 1000 watts. These do not use phosphors, but rely on the intensified and slightly broadened 350375nm spectral line of mercury from high pressure discharge at between 5 and 10 standard atmospheres (500 and 1,000kPa), depending upon the specific type.
1742
Laparoscopic robotic assisted procedure
ICD
CS1 maint: Uses authors parameter (link) For other uses, seeBlack Light (disambiguation). Operations/surgeriesand other procedures of theskinandsubcutaneous tissueICD-9-CM V386,ICD-10-PCS 0H) (7): 10534.PMID17427621Archivedfrom the original on 2008-08-28. CS1 maint: Uses authors parameter (link) High powermercury vaporblack light lamps are made in power ratings of 100 to 1000 watts. These do not use phosphors, but rely on the intensified and slightly broadened 350375nm spectral line of mercury from high pressure discharge at between 5 and 10 standard atmospheres (500 and 1,000kPa), depending upon the specific type. These lamps use envelopes of Woods glass or similar optical filter coatings to block out all the visible light and also the short wavelength (UVC) lines of mercury at 184.4 and 253.7nm, which are harmful to the eyes and skin.
1742
Laparoscopic robotic assisted procedure
ICD
Operations/surgeriesand other procedures of theskinandsubcutaneous tissueICD-9-CM V386,ICD-10-PCS 0H) (7): 10534.PMID17427621Archivedfrom the original on 2008-08-28. CS1 maint: Uses authors parameter (link) High powermercury vaporblack light lamps are made in power ratings of 100 to 1000 watts. These do not use phosphors, but rely on the intensified and slightly broadened 350375nm spectral line of mercury from high pressure discharge at between 5 and 10 standard atmospheres (500 and 1,000kPa), depending upon the specific type. These lamps use envelopes of Woods glass or similar optical filter coatings to block out all the visible light and also the short wavelength (UVC) lines of mercury at 184.4 and 253.7nm, which are harmful to the eyes and skin. A few other spectral lines, falling within the pass band of the Woods glass between 300 and 400nm, contribute to the output.
00216
ANESTH HEAD VESSEL SURGERY
CPT
For the procedure, we’d code 23140 for “excision or curretage of bone cyst or benign tumor, humerus; with autograft (includes obtaining the graft).” Since the procedure was completed but not fully successful, we’d add the -52 modifier, for reduced services, to the code, and we’d end up with 23140-52. Physical Status Modifier (for Anesthesia) Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are: - P1 – a normal, healthy patient - P2 – a patient with mild systemic disease - P3 – a patient with severe systemic disease - P4 – a patient with severe systemic disease that is a constant threat to life - P5 – a moribund patient who is not expected to survive without the operation - P6 – a declared brain-dead patient whose organs are being removed for donor purposes As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1.
00216
ANESTH HEAD VESSEL SURGERY
CPT
These codes are: - P1 – a normal, healthy patient - P2 – a patient with mild systemic disease - P3 – a patient with severe systemic disease - P4 – a patient with severe systemic disease that is a constant threat to life - P5 – a moribund patient who is not expected to survive without the operation - P6 – a declared brain-dead patient whose organs are being removed for donor purposes As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day.
00216
ANESTH HEAD VESSEL SURGERY
CPT
Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. Note that there may be some overlap or contradiction with the set of HCPCS modifiers, which we’ll cover in more depth later on.
0212
Other Inpatient
RC
University of Michigan Health System 1500 E. Medical Center Drive Ann Arbor, MI 48109 Sherman Leis, D.O., F.A.C.O.S. The Center For Plastic And Reconstructive Surgery 19 Montgomery Avenue Bala Cynwyd, PA 19004 Ellie Zara Ley, MD 7025 N. Scottsdale Rd, Suite 302 Scottsdale, AZ 85253 Christine McGinn, MD Papillon Gender Wellness Center 18 Village Row New Hope, PA 18938 Toby R Meltzer, MD, PC 7025 N. Scottsdale Rd, Suite 302 Scottsdale, AZ 85253 Tuan A. Nguyen, M.D., D.D.S. 15820 Quarry Road Lake Oswego, OR 97035 Harold M. Reed, M.D., F.I.C.S. 1111 Kane Concourse Bay Harbor, Florida 33154 Kathy Rumer, MD, FACOS Rumer Cosmetic Surgery 105 Ardmore Avenue Ardmore, PA 19003 575 Sir Francis Drake Blvd Greenbrae, CA 94904 University Plastic Surgery, 9000 Waukegan Rd, Suite 210, Morton Grove, IL, 60053, US Christopher Salgado, MD 1120 NW 14th Street Miami, FL 33136 9884 South Santa Monica Blvd Beverly Hills, CA 90212 Heidi Wittenberg, MD Urogynecology Center of San Francisco 55 Francisco Street, #300 San Francisco, CA 94133 NEW! DR. RIAN MAERCKS, M.D.