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15.5k
G0340
Robt lin-radsurg fractx 2-5
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
31287
PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
G0339
Robot lin-radsurg com, first
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
31276
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
S8030
Tantalum ring application
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
31290
PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
31256
PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
31267
PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
61795
Brain surgery using computer
HCPCS
POLICY HISTORY9/1992: Approved by Medical Policy Advisory Committee (MPAC) 9/1994: Reviewed and updated by MPAC 10/1996: Reviewed and updated by MPAC 2/2001: Reviewed by MPAC; Proton beam therapy for prostate cancer considered investigational 4/3/2001: Code Reference updated 5/8/2001: Proton Beam is medically necessary...
31254
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
31294
PR NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
61548
Removal of pituitary gland
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
31288
PR NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
G0340
Robt lin-radsurg fractx 2-5
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
31287
PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
G0339
Robot lin-radsurg com, first
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
31276
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
S8030
Tantalum ring application
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
31290
PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
31256
PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
31267
PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
61795
Brain surgery using computer
HCPCS
9/5/2001: Trigeminal Neuralgia refractory to medical management added as covered indication 2/13/2002: Investigational definition added 3/5/2002: Prior authorization added 3/12/2002: New 2002 codes added 5/8/2002: Type of Service and Place of Service deleted 9/20/2002: Policy reviewed, Hayes report number added 12/4/20...
31254
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
31294
PR NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
61548
Removal of pituitary gland
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
31288
PR NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
31287
PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
31276
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
31290
PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
S8030
Tantalum ring application
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
31256
PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
31267
PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
61795
Brain surgery using computer
HCPCS
Some examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294, and 61548" added, for clarification of CPT code 61795 "Note" added to See "Policy"section for specific coverage of Stereotactic Radiosurgery 3/14/2006: Coding updated. HCPCS 2005 revisions added to poli...
S8030
Tantalum ring application
HCPCS
HCPCS 2005 revisions added to policy 7/20/2006: Policy reviewed, prior authorization removed 8/18/2006: Policy and description rewritten and clarified; investigational status of extracranial sites added 9/5/2006: Code reference section udpated. CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 del...
61795
Brain surgery using computer
HCPCS
HCPCS 2005 revisions added to policy 7/20/2006: Policy reviewed, prior authorization removed 8/18/2006: Policy and description rewritten and clarified; investigational status of extracranial sites added 9/5/2006: Code reference section udpated. CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 del...
77372
Srs linear based
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77432
Stereotactic radiation trmt
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77522
Proton trmt simple w/comp
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
63621
Srs spinal lesion addl
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77371
HC RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
61795
Brain surgery using computer
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
G0243
MX-SRC PHOTON STERO RADIOSURG DEL W/COLLMTR CHGS
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77373
Sbrt delivery
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77299
HC UNLIS PX THER RADIOL CLINICAL TX PLANNING
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77416
Radiation treatment delivery
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77523
Proton trmt intermediate
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
63620
Srs spinal lesion
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77435
HC STEREOTACTIC BODY RADIATION MANAGEMENT
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77399
HC UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
61793
Focus Radiation Beam
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77520
Proton trmt simple w/o comp
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
61799
Srs cran les complex addl
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
20660
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77402
HC RAD TX> 1MEV, SIMPLE
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77525
Proton treatment complex
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
S8030
Tantalum ring application
HCPCS
CPT code 61795 deleted. ICD9 procedure codes 92.31, 92.32, 92.33, 92.39 deleted. ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy re...
77372
Srs linear based
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77432
Stereotactic radiation trmt
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77522
Proton trmt simple w/comp
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
63621
Srs spinal lesion addl
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77371
HC RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
61795
Brain surgery using computer
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
G0243
MX-SRC PHOTON STERO RADIOSURG DEL W/COLLMTR CHGS
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77373
Sbrt delivery
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77299
HC UNLIS PX THER RADIOL CLINICAL TX PLANNING
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77416
Radiation treatment delivery
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77523
Proton trmt intermediate
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
63620
Srs spinal lesion
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77435
HC STEREOTACTIC BODY RADIATION MANAGEMENT
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77399
HC UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
61793
Focus Radiation Beam
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77520
Proton trmt simple w/o comp
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
61799
Srs cran les complex addl
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
20660
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77402
HC RAD TX> 1MEV, SIMPLE
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77525
Proton treatment complex
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
S8030
Tantalum ring application
HCPCS
ICD9 diagnosis codes 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 197.0, 231.2, 237.0, 237.1, 253.0, 255.0, 332.0, 333.1, HCPC S8030 deleted 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 9/18/2007: Policy reviewed, no changes 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 12/31/...
77372
Srs linear based
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77432
Stereotactic radiation trmt
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77522
Proton trmt simple w/comp
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
63621
Srs spinal lesion addl
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77371
HC RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
61795
Brain surgery using computer
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
G0243
MX-SRC PHOTON STERO RADIOSURG DEL W/COLLMTR CHGS
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77373
Sbrt delivery
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77299
HC UNLIS PX THER RADIOL CLINICAL TX PLANNING
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77416
Radiation treatment delivery
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77523
Proton trmt intermediate
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
61781
Scan proc cranial intra
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
63620
Srs spinal lesion
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77435
HC STEREOTACTIC BODY RADIATION MANAGEMENT
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77399
HC UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
61793
Focus Radiation Beam
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
61783
Scan proc spinal
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77520
Proton trmt simple w/o comp
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
61799
Srs cran les complex addl
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
20660
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77402
HC RAD TX> 1MEV, SIMPLE
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
77525
Proton treatment complex
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...
S8030
Tantalum ring application
HCPCS
Coding Section revised to include coding information guidelines for describing the procedure and delivery reporting, added verbiage to CPT4 code 20660 "(this code may have been used previous to 1-1-2009 to code the attachment of the head frame), added verbiage to CPT 4 codes 61795- 61799 "(Use for clinical treatment ma...