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15.5k
1999
ANESTHESIOLOGY GROUP
CPT
structured form (progress notes) that allows dr's to document pt encounters into an EHR, once it is entered it must be INTEROPERABLE: must be able to exchange info and use it in a meaningful way, therefore clinical standards are important to the details of pt info Types of Clinical Standards -CLINICAL VOCABULARIES- set...
00100
ANESTH SALIVARY GLAND
CPT
structured form (progress notes) that allows dr's to document pt encounters into an EHR, once it is entered it must be INTEROPERABLE: must be able to exchange info and use it in a meaningful way, therefore clinical standards are important to the details of pt info Types of Clinical Standards -CLINICAL VOCABULARIES- set...
01999
Unlisted anesth procedure
CPT
structured form (progress notes) that allows dr's to document pt encounters into an EHR, once it is entered it must be INTEROPERABLE: must be able to exchange info and use it in a meaningful way, therefore clinical standards are important to the details of pt info Types of Clinical Standards -CLINICAL VOCABULARIES- set...
1999
ANESTHESIOLOGY GROUP
CPT
they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions ICD-9 and ICD-10 International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings...
00100
ANESTH SALIVARY GLAND
CPT
they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions ICD-9 and ICD-10 International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings...
01999
Unlisted anesth procedure
CPT
they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions ICD-9 and ICD-10 International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings...
1999
ANESTHESIOLOGY GROUP
CPT
DIAGNOSIS USAGE: Inpatient & Outpatient *Number of characters: 3-5 alphanumeric *Number of Codes: 13,000 PROCEDURE USAGE: Inpatient* *# of characters: 3-4 numeric *# of codes 4,000 DIAGNOSIS USAGE: inpatient & outpatient *# of characters: 3-7 alphanumeric *# of codes: 120,00 PROCEDURE USAGE: none DIAGNOSIS USAGE: none ...
00100
ANESTH SALIVARY GLAND
CPT
DIAGNOSIS USAGE: Inpatient & Outpatient *Number of characters: 3-5 alphanumeric *Number of Codes: 13,000 PROCEDURE USAGE: Inpatient* *# of characters: 3-4 numeric *# of codes 4,000 DIAGNOSIS USAGE: inpatient & outpatient *# of characters: 3-7 alphanumeric *# of codes: 120,00 PROCEDURE USAGE: none DIAGNOSIS USAGE: none ...
01999
Unlisted anesth procedure
CPT
DIAGNOSIS USAGE: Inpatient & Outpatient *Number of characters: 3-5 alphanumeric *Number of Codes: 13,000 PROCEDURE USAGE: Inpatient* *# of characters: 3-4 numeric *# of codes 4,000 DIAGNOSIS USAGE: inpatient & outpatient *# of characters: 3-7 alphanumeric *# of codes: 120,00 PROCEDURE USAGE: none DIAGNOSIS USAGE: none ...
1999
ANESTHESIOLOGY GROUP
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY4/1993: Approved by Medical Policy Advisory Committee (MPAC) 2/1997: Expanded clinical indications approved by MPAC. Limited to DEXA method only, once every 12 months. 6...
1999
ANESTHESIOLOGY GROUP
CPT
POLICY HISTORY4/1993: Approved by Medical Policy Advisory Committee (MPAC) 2/1997: Expanded clinical indications approved by MPAC. Limited to DEXA method only, once every 12 months. 6/1999: Interim policy revision: Included use of quantitative ultrasound (QUS) as an approved method 8/1999: Addition of QUS approved by M...
1999
ANESTHESIOLOGY GROUP
CPT
Limited to DEXA method only, once every 12 months. 6/1999: Interim policy revision: Included use of quantitative ultrasound (QUS) as an approved method 8/1999: Addition of QUS approved by MPAC 11/2000: Reviewed by MPAC; no changes 5/21/2001: Code Reference section revised; non-covered codes table added 10/15/2001: Verb...
1999
ANESTHESIOLOGY GROUP
CPT
6/1999: Interim policy revision: Included use of quantitative ultrasound (QUS) as an approved method 8/1999: Addition of QUS approved by MPAC 11/2000: Reviewed by MPAC; no changes 5/21/2001: Code Reference section revised; non-covered codes table added 10/15/2001: Verbiage revised under "policy" section; "Reimbursement...
76075
Dxa bone density, axial
HCPCS
2/14/2002: Investigational definition added 4/18/2002: Type of Service and Place of Service deleted 6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added 3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substant...
76071
Ct bone density, peripheral
HCPCS
2/14/2002: Investigational definition added 4/18/2002: Type of Service and Place of Service deleted 6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added 3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substant...
76077
Dxa bone density/v-fracture
HCPCS
2/14/2002: Investigational definition added 4/18/2002: Type of Service and Place of Service deleted 6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added 3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substant...
76076
Dxa bone density/peripheral
HCPCS
2/14/2002: Investigational definition added 4/18/2002: Type of Service and Place of Service deleted 6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added 3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substant...
76077
Dxa bone density/v-fracture
HCPCS
556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted 9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556...
76077
Dxa bone density/v-fracture
HCPCS
Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid. Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section ...
76077
Dxa bone density/v-fracture
HCPCS
Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th d...
G0130
Single energy x-ray study
HCPCS
Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th d...
76077
Dxa bone density/v-fracture
HCPCS
HCPCS 2006 revisions added to policy 09/13/2006: Coding updated. ICD9 2006 revisions added to policy 09/25/2006: Policy clarified and partially rewritten 10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "inc...
G0130
Single energy x-ray study
HCPCS
HCPCS 2006 revisions added to policy 09/13/2006: Coding updated. ICD9 2006 revisions added to policy 09/25/2006: Policy clarified and partially rewritten 10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "inc...
76077
Dxa bone density/v-fracture
HCPCS
ICD9 2006 revisions added to policy 09/25/2006: Policy clarified and partially rewritten 10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to wo...
G0130
Single energy x-ray study
HCPCS
ICD9 2006 revisions added to policy 09/25/2006: Policy clarified and partially rewritten 10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to wo...
76075
Dxa bone density, axial
HCPCS
CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007:...
76077
Dxa bone density/v-fracture
HCPCS
CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007:...
G0130
Single energy x-ray study
HCPCS
CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007:...
76076
Dxa bone density/peripheral
HCPCS
CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007:...
76075
Dxa bone density, axial
HCPCS
HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007: Coding updated.CPT/HCPCS 2008 revision...
Q9952
Inj Gad-base MR contrast,1ml
HCPCS
HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007: Coding updated.CPT/HCPCS 2008 revision...
G0130
Single energy x-ray study
HCPCS
HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007: Coding updated.CPT/HCPCS 2008 revision...
76076
Dxa bone density/peripheral
HCPCS
HCPC code G0130 added to non-covered table 12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007: Coding updated.CPT/HCPCS 2008 revision...
76075
Dxa bone density, axial
HCPCS
Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy 9/17/2008: Annual ICD-9 updates effective 10-1-2008 app...
Q9952
Inj Gad-base MR contrast,1ml
HCPCS
Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy 9/17/2008: Annual ICD-9 updates effective 10-1-2008 app...
76076
Dxa bone density/peripheral
HCPCS
Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause 12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions 12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy 9/17/2008: Annual ICD-9 updates effective 10-1-2008 app...
L7190
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
HCPCS
07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis ...
L7191
Electronic elbow, child, variety village or equal, myoelectronically controlled
HCPCS
07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis ...
L6880
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
HCPCS
07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis ...
L7190
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
HCPCS
09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy sta...
L7191
Electronic elbow, child, variety village or equal, myoelectronically controlled
HCPCS
09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy sta...
L6880
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
HCPCS
09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy sta...
L6026
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr
HCPCS
Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026.
L7190
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
HCPCS
Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026.
L7191
Electronic elbow, child, variety village or equal, myoelectronically controlled
HCPCS
Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026.
L6880
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
HCPCS
Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026.
L6026
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr
HCPCS
08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. SOURCESBlue Cross Blue Shield Association policy # 1.04.04 CODE REFERENCEThis ...
L6026
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr
HCPCS
Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. SOURCESBlue Cross Blue Shield Association policy # 1.04.04 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to thi...
L6026
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr
HCPCS
12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. SOURCESBlue Cross Blue Shield Association policy # 1.04.04 CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed...
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
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 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 Devic...
33978
Remove ventricular device
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
33977
Remove ventricular device
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
0052T
Replace thrc unit hrt syst
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
33976
PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
33975
PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
0050T
Removal circulation assist
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
0053T
Replace implantable hrt syst
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
Q0480
Driver pneumatic vad, rep
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
0048T
Implant ventricular device
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
0051T
Implant total heart system
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 2/14/2002: Investigational definition added 3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic...
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...
70542
MRI scan of bone of eye socket, face, and/or neck with contrast
HCPCS
This is in accordance with the findings of Ayache and associates (2000) who concluded that assessment of perilymphatic pressure does not seem to be useful in Meniere's disease. Furthermore, Rosingh and co-workers (2000) reported that perilymphatic pressure measured in the affected ear of patients with Meniere's disease...
92588
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
HCPCS
This is in accordance with the findings of Ayache and associates (2000) who concluded that assessment of perilymphatic pressure does not seem to be useful in Meniere's disease. Furthermore, Rosingh and co-workers (2000) reported that perilymphatic pressure measured in the affected ear of patients with Meniere's disease...
92587
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
HCPCS
This is in accordance with the findings of Ayache and associates (2000) who concluded that assessment of perilymphatic pressure does not seem to be useful in Meniere's disease. Furthermore, Rosingh and co-workers (2000) reported that perilymphatic pressure measured in the affected ear of patients with Meniere's disease...