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0052T
Replace thrc unit hrt syst
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 m...
33976
PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR
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 m...
33975
PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE
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 m...
0050T
Removal circulation assist
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 m...
0053T
Replace implantable hrt syst
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 m...
Q0480
Driver pneumatic vad, rep
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 m...
0048T
Implant ventricular device
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 m...
0051T
Implant total heart system
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 m...
0049T
External circulation assist
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
33978
Remove ventricular device
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
33977
Remove ventricular device
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
0052T
Replace thrc unit hrt syst
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
33976
PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
33975
PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
0050T
Removal circulation assist
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
0053T
Replace implantable hrt syst
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
Q0480
Driver pneumatic vad, rep
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
0048T
Implant ventricular device
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
0051T
Implant total heart system
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
0049T
External circulation assist
CPT
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
33978
Remove ventricular device
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
33977
Remove ventricular device
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
0052T
Replace thrc unit hrt syst
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
33976
PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
33975
PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
0050T
Removal circulation assist
CPT
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
0053T
Replace implantable hrt syst
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
Q0480
Driver pneumatic vad, rep
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
0048T
Implant ventricular device
CPT
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
0051T
Implant total heart system
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational...
0053T
Replace implantable hrt syst
HCPCS
Ventricular assist devices as destination therapy with end-stage heart failure changed from investigational to medically necessary for FDA-approved devices in patients ineligible for human heart transplant. Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. I...
0051T
Implant total heart system
HCPCS
Ventricular assist devices as destination therapy with end-stage heart failure changed from investigational to medically necessary for FDA-approved devices in patients ineligible for human heart transplant. Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. I...
Q4079
Natalizumab injection
HCPCS
Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. ICD-9 procedure codes 37.52-37.54 moved to covered 9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied 12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions 8/19/2009: Policy reviewe...
0053T
Replace implantable hrt syst
HCPCS
Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. ICD-9 procedure codes 37.52-37.54 moved to covered 9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied 12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions 8/19/2009: Policy reviewe...
0051T
Implant total heart system
HCPCS
Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. ICD-9 procedure codes 37.52-37.54 moved to covered 9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied 12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions 8/19/2009: Policy reviewe...
Q4079
Natalizumab injection
HCPCS
ICD-9 procedure codes 37.52-37.54 moved to covered 9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied 12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions 8/19/2009: Policy reviewed, no changes 03/12/2010: Coding Section revised for 2010 CPT4 and HCPCS revision 12/30/2010: Policy description...
Q4079
Natalizumab injection
HCPCS
Policy statements revised to address only implantable VADs and total artificial hearts. 03/09/2011: Added new HCPCS codes Q4078 and Q4079 to the Code Reference section. 12/13/2011: Policy description and statement updated regarding percutaneous ventricular assist devices. Added the following policy statement: Percutane...
0048T
Implant ventricular device
CPT
Replaced "cleared devices" with "clearance." Added "Implantable" to the beggining of the policy statement under the Bridge to Transplantation section. Policy statement on implantable VADs as a bridge to heart tranplantation in children was revised to change the age range from "5 to 16" to "16 years old or younger," ref...
0050T
Removal circulation assist
CPT
Replaced "cleared devices" with "clearance." Added "Implantable" to the beggining of the policy statement under the Bridge to Transplantation section. Policy statement on implantable VADs as a bridge to heart tranplantation in children was revised to change the age range from "5 to 16" to "16 years old or younger," ref...
0048T
Implant ventricular device
CPT
Policy statement on implantable VADs as a bridge to heart tranplantation in children was revised to change the age range from "5 to 16" to "16 years old or younger," reflecting the approval of the BERLIN heart EXCOR device for pediatric patients. Policy guidelines updated to include coagulation disorders and inadequate...
0050T
Removal circulation assist
CPT
Policy statement on implantable VADs as a bridge to heart tranplantation in children was revised to change the age range from "5 to 16" to "16 years old or younger," reflecting the approval of the BERLIN heart EXCOR device for pediatric patients. Policy guidelines updated to include coagulation disorders and inadequate...
0048T
Implant ventricular device
CPT
Policy guidelines updated to include coagulation disorders and inadequate psychosocial support as contraindications for bridge to transplant VADs and TAH. Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 3...
0050T
Removal circulation assist
CPT
Policy guidelines updated to include coagulation disorders and inadequate psychosocial support as contraindications for bridge to transplant VADs and TAH. Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 3...
0048T
Implant ventricular device
CPT
Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 33990, 33991, 33992, 33993 and ICD-9 procedure code 37.68 moved from Covered to Investigational. 08/27/2015: Code Reference section updated for ICD-10. Remo...
0050T
Removal circulation assist
CPT
Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 33990, 33991, 33992, 33993 and ICD-9 procedure code 37.68 moved from Covered to Investigational. 08/27/2015: Code Reference section updated for ICD-10. Remo...
L8684
Radiof trsmtr implt scrl neu
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8689
SYSTEM CHARGING AXONICS WRELS
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8680
KIT NRSTM 40CM STIMLOC .
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8683
TRANSMITTER SGL
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8682
Implt neurostim radiofq rec
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8681
REMOTE SLEEP
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8686
Implt nrostm pls gen sng non
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8687
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8685
Implt nrostm pls gen sng rec
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8688
Implt nrostm pls gen dua non
HCPCS
PMID 19732075 - National Institute for Health and Care Excellence. IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||In...
L8684
Radiof trsmtr implt scrl neu
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8689
SYSTEM CHARGING AXONICS WRELS
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8680
KIT NRSTM 40CM STIMLOC .
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8683
TRANSMITTER SGL
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8682
Implt neurostim radiofq rec
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8681
REMOTE SLEEP
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8686
Implt nrostm pls gen sng non
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8687
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8685
Implt nrostm pls gen sng rec
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8688
Implt nrostm pls gen dua non
HCPCS
IPG452 Occipital nerve stimulation for intractable chronic migraine. 2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurost...
L8684
Radiof trsmtr implt scrl neu
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8689
SYSTEM CHARGING AXONICS WRELS
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8680
KIT NRSTM 40CM STIMLOC .
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8683
TRANSMITTER SGL
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8682
Implt neurostim radiofq rec
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8681
REMOTE SLEEP
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8686
Implt nrostm pls gen sng non
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8687
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8685
Implt nrostm pls gen sng rec
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8688
Implt nrostm pls gen dua non
HCPCS
2013; http://publications.nice.org.uk/occipital-nerve-stimulation-for-intractable-chronic-migraine-ipg452. Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, ...
L8684
Radiof trsmtr implt scrl neu
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8689
SYSTEM CHARGING AXONICS WRELS
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8680
KIT NRSTM 40CM STIMLOC .
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8683
TRANSMITTER SGL
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8682
Implt neurostim radiofq rec
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8681
REMOTE SLEEP
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8686
Implt nrostm pls gen sng non
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8687
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8685
Implt nrostm pls gen sng rec
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8688
Implt nrostm pls gen dua non
HCPCS
Accessed September 9, 2014. |CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (eff...
L8684
Radiof trsmtr implt scrl neu
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8689
SYSTEM CHARGING AXONICS WRELS
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8680
KIT NRSTM 40CM STIMLOC .
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8683
TRANSMITTER SGL
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8682
Implt neurostim radiofq rec
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8681
REMOTE SLEEP
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8686
Implt nrostm pls gen sng non
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8687
KIT NEUROSTIMULATOR SENZA IPG STERILE LATEX FREE DISPOSABLE
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8685
Implt nrostm pls gen sng rec
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
L8688
Implt nrostm pls gen dua non
HCPCS
|CPT||See Policy Guidelines| |ICD-9 Diagnosis||Investigational for all diagnoses| |HCPCS||L8680||Implantable neurostimulator electrode, each| |L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689||Implantable neurostimulator programmer and pulse generator code range| |ICD-10-CM (effective 10/1/15)||Investigati...
G0281
PR ELEC STIM UNATTEND FOR PRESS
HCPCS
Electrical stimulation performed by the patient in the home setting for the treatment of wounds is considered investigational. Electromagnetic therapy for the treatment of wounds is considered investigational. The following HCPCS codes are available for this treatment: G0281: Electrical stimulation (unattended), to one...
G0282
HC ELECTRICAL STIMULATION, TO ONE OR MORE AREAS, FOR WOUND CARE
HCPCS
Electrical stimulation performed by the patient in the home setting for the treatment of wounds is considered investigational. Electromagnetic therapy for the treatment of wounds is considered investigational. The following HCPCS codes are available for this treatment: G0281: Electrical stimulation (unattended), to one...
G0329
PR ELECTROMAGNTIC TX FOR ULCERS
HCPCS
Electrical stimulation performed by the patient in the home setting for the treatment of wounds is considered investigational. Electromagnetic therapy for the treatment of wounds is considered investigational. The following HCPCS codes are available for this treatment: G0281: Electrical stimulation (unattended), to one...
G0295
Electromagnetic therapy onc
HCPCS
Electrical stimulation performed by the patient in the home setting for the treatment of wounds is considered investigational. Electromagnetic therapy for the treatment of wounds is considered investigational. The following HCPCS codes are available for this treatment: G0281: Electrical stimulation (unattended), to one...
G0281
PR ELEC STIM UNATTEND FOR PRESS
HCPCS
Electromagnetic therapy for the treatment of wounds is considered investigational. The following HCPCS codes are available for this treatment: G0281: Electrical stimulation (unattended), to one or more areas, for chronic stage III and stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers ...