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38209
Wash harvest stem cells
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0360
Each additional hr 1-8 hrs
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38204
PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38213
PR TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38215
PR TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
J9999
Not otherwise classified, antineoplastic drugs
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0361
Prolong chemo infuse>8hrs pu
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38211
Tumor cell deplete of harvst
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38207
PR TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38208
Thaw preserved stem cells
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0359
Chemotherapy IV one hr initi
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38210
T-cell depletion of harvest
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38230
PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38212
Rbc depletion of harvest
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0363
IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
J9000
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0364
HC BONE MARROW ASPIRATE & BIOPSY
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
38205
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0362
Each add sequential infusion
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0357
IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0356
HORMONAL ANTINEOPLASTIC
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0355
CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC
HCPCS
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8...
G0358
IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38214
Volume deplete of harvest
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38209
Wash harvest stem cells
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0360
Each additional hr 1-8 hrs
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38204
PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38213
PR TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38215
PR TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
J9999
Not otherwise classified, antineoplastic drugs
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0361
Prolong chemo infuse>8hrs pu
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38211
Tumor cell deplete of harvst
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38207
PR TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38208
Thaw preserved stem cells
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0359
Chemotherapy IV one hr initi
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38210
T-cell depletion of harvest
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38230
PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38212
Rbc depletion of harvest
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0363
IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
J9000
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0364
HC BONE MARROW ASPIRATE & BIOPSY
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
38205
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0362
Each add sequential infusion
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0357
IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0356
HORMONAL ANTINEOPLASTIC
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0355
CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC
HCPCS
POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22 8/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC; no changes 10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38...
G0267
Bone marrow or psc harvest
CPT
ICD9 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy 12/20/2007: Coding updated per 2008 CPT/HCPCS revisions 9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc...
G0266
Thawing + expansion froz cel
CPT
ICD9 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy 12/20/2007: Coding updated per 2008 CPT/HCPCS revisions 9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc...
G0265
Cryopresevation Freeze+stora
CPT
ICD9 2006 revisions added to policy 12/21/2006: Policy reviewed, no changes 9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy 12/20/2007: Coding updated per 2008 CPT/HCPCS revisions 9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc...
G0267
Bone marrow or psc harvest
CPT
ICD-9 2007 revisions added to policy 12/20/2007: Coding updated per 2008 CPT/HCPCS revisions 9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ...
G0266
Thawing + expansion froz cel
CPT
ICD-9 2007 revisions added to policy 12/20/2007: Coding updated per 2008 CPT/HCPCS revisions 9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ...
G0265
Cryopresevation Freeze+stora
CPT
ICD-9 2007 revisions added to policy 12/20/2007: Coding updated per 2008 CPT/HCPCS revisions 9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ...
30233G3
TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
30243Y2
TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
0233
Incremental Nursing Charge - ICU
RC
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
30233Y3
TRANSFUSION OF ALLOGENEIC UNRELATED HAMATOPOIETIC STEM CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
30243G2
TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
30233G2
TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
30233Y2
TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
0243
All Inclusive Ancillary - Specialty
RC
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
30243Y3
TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
30243G3
TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
Policy guidelines section updated to add guidelines for primary immunodeficiencies and inherited metabolic disease. Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30...
30233G3
TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
30243Y2
TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
0233
Incremental Nursing Charge - ICU
RC
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
30233Y3
TRANSFUSION OF ALLOGENEIC UNRELATED HAMATOPOIETIC STEM CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
30243G2
TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
30233G2
TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
30233Y2
TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
0243
All Inclusive Ancillary - Specialty
RC
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
30243Y3
TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
30243G3
TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
Added medically necessary definition. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association pol...
30233G3
TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
30243Y2
TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
0233
Incremental Nursing Charge - ICU
RC
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
30233Y3
TRANSFUSION OF ALLOGENEIC UNRELATED HAMATOPOIETIC STEM CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
30243G2
TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
30233G2
TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
30233Y2
TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg
ICD
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
0243
All Inclusive Ancillary - Specialty
RC
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
30243Y3
TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
30243G3
TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU
ICD
09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30233G2, 30233G3, 30233G4, 30233Y2, 30233Y3, 30233Y4, 30243G2, 30243G3, 30243Y2, 30243Y3, and 30243Y4. Added new ICD-10 diagnosis code D47.Z2. SOURCE(S)Blue Cross Blue Shield Association policy # 8.01.22 CODE REFERENCEThis may n...
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 ...
G0282
HC ELECTRICAL STIMULATION, TO ONE OR MORE AREAS, FOR WOUND CARE
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 ...
G0329
PR ELECTROMAGNTIC TX FOR ULCERS
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 ...
G0295
Electromagnetic therapy onc
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 ...
E0761
Nontherm electromgntc device
HCPCS
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 not demonstrating measurable signs of healing after 30 days of conventional care, a...
G0282
HC ELECTRICAL STIMULATION, TO ONE OR MORE AREAS, FOR WOUND CARE
HCPCS
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 not demonstrating measurable signs of healing after 30 days of conventional care, a...
G0329
PR ELECTROMAGNTIC TX FOR ULCERS
HCPCS
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 not demonstrating measurable signs of healing after 30 days of conventional care, a...
G0295
Electromagnetic therapy onc
HCPCS
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 not demonstrating measurable signs of healing after 30 days of conventional care, a...
G0281
PR ELEC STIM UNATTEND FOR PRESS
HCPCS
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 not demonstrating measurable signs of healing after 30 days of conventional care, a...
E0761
Nontherm electromgntc device
HCPCS
G0295: Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses. G0329: Electromagnetic therapy, to one or more areas, for chronic stage III or stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of ...
G0329
PR ELECTROMAGNTIC TX FOR ULCERS
HCPCS
G0295: Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses. G0329: Electromagnetic therapy, to one or more areas, for chronic stage III or stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of ...
G0295
Electromagnetic therapy onc
HCPCS
G0295: Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses. G0329: Electromagnetic therapy, to one or more areas, for chronic stage III or stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of ...
E0769
Electric wound treatment dev
HCPCS
G0295: Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses. G0329: Electromagnetic therapy, to one or more areas, for chronic stage III or stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of ...
G0281
PR ELEC STIM UNATTEND FOR PRESS
HCPCS
G0295: Electromagnetic therapy, to one or more areas, for wound care other than described in G0329 or for other uses. G0329: Electromagnetic therapy, to one or more areas, for chronic stage III or stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of ...