code stringlengths 4 12 | description stringlengths 2 264 | codetype stringclasses 8
values | context stringlengths 160 15.5k |
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G6016 | PR DELIVERY COMP IMRT | HCPCS | Added policy statement: IMRT is considered investigational for the treatment of prostate cancer when the above criteria are not met. Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2... |
G6015 | Radiation tx delivery imrt | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: P... |
77386 | HC IMRT COMPLEX | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: P... |
77385 | HC IMRT SIMPLE | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: P... |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Policy guidelines updated regarding localized prostate cancer. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: P... |
G6015 | Radiation tx delivery imrt | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statem... |
77386 | HC IMRT COMPLEX | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statem... |
77385 | HC IMRT SIMPLE | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statem... |
G6016 | PR DELIVERY COMP IMRT | HCPCS | 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statem... |
G6015 | Radiation tx delivery imrt | HCPCS | Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statements unchanged. Policy Guidelines section updated to add medically necessary and investigative defi... |
G6016 | PR DELIVERY COMP IMRT | HCPCS | Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/28/2015: Medical policy revised to add ICD-10 codes. 09/16/2015: Policy description updated regarding IMRT systems. Policy statements unchanged. Policy Guidelines section updated to add medically necessary and investigative defi... |
1745 | Thoracoscopic robotic assisted procedure | ICD | PMID 17141745. - World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. |
D7873 | Tmj arthroscopy lysis adhesn | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
96000 | PR COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
70320 | Full mouth x-ray of teeth | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
93762 | Peripheral Thermogram | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D7877 | Tmj arthroscopy debridement | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
96004 | PR PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
70310 | X-ray exam of teeth | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
70300 | X-ray exam of teeth | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
S8262 | MANDIB ORTHO REPOSITION DEVICE EACH | CPT | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
93760 | Cephalic Thermogram | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D8999 | PR UNS ORTHODONTIC PROCEDURE BY REPORT | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D8010 | PR LTD ORTHODONT TX PRIMARY DENTITION | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D0330 | PR PANORAMIC RADIOGRAPHIC IMAGE | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
70328 | XR TMJ UNILATERAL | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D2999 | PR UNSPEC RESTORATIVE PROC BY REPORT | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D0230 | PR IO-PERIAPICAL EA ADD RADIOGRPH IMAG | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
21240 | Reconstruction of jaw joint | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
70332 | X-ray exam of jaw joint | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
21243 | Reconstruction of jaw joint | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D1510 | Space maintainer fxd unilat | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
70250 | XR Skull < 4 Views | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D1550 | Recement space maintainer | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
95867 | PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D2940 | PR PROTECTIVE RESTORATION | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D5899 | Removable prosthodontic proc | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
70260 | XR SKULL 4 VIEWS | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
95868 | PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D0210 | PR INTRAORAL-CMPL SER RADIOGRAPH IMAGS | HCPCS | There are lifetime contractual limits depending on the individual contract. This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70... |
D7873 | Tmj arthroscopy lysis adhesn | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
96000 | PR COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
70320 | Full mouth x-ray of teeth | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
93762 | Peripheral Thermogram | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D7877 | Tmj arthroscopy debridement | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
96004 | PR PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
70310 | X-ray exam of teeth | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
70300 | X-ray exam of teeth | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
S8262 | MANDIB ORTHO REPOSITION DEVICE EACH | CPT | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
93760 | Cephalic Thermogram | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D8999 | PR UNS ORTHODONTIC PROCEDURE BY REPORT | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D8010 | PR LTD ORTHODONT TX PRIMARY DENTITION | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D0330 | PR PANORAMIC RADIOGRAPHIC IMAGE | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
70328 | XR TMJ UNILATERAL | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D2999 | PR UNSPEC RESTORATIVE PROC BY REPORT | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D0230 | PR IO-PERIAPICAL EA ADD RADIOGRPH IMAG | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
21240 | Reconstruction of jaw joint | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
70332 | X-ray exam of jaw joint | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
21243 | Reconstruction of jaw joint | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D1510 | Space maintainer fxd unilat | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
70250 | XR Skull < 4 Views | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D1550 | Recement space maintainer | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
95867 | PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D2940 | PR PROTECTIVE RESTORATION | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D5899 | Removable prosthodontic proc | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
70260 | XR SKULL 4 VIEWS | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
95868 | PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D0210 | PR INTRAORAL-CMPL SER RADIOGRAPH IMAGS | HCPCS | This therapy will fall within those limits. Sources updated
12/16/2002: HCPCS S8262 added
3/2003: Reviewed by MPAC; Passive Rehabilitation Therapy for Mandibular Hypomobility considered not medically necessary. Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-... |
D7873 | Tmj arthroscopy lysis adhesn | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
96000 | PR COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
70320 | Full mouth x-ray of teeth | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
93762 | Peripheral Thermogram | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D7877 | Tmj arthroscopy debridement | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
96004 | PR PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
21070 | Remove coronoid process | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
70310 | X-ray exam of teeth | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
70300 | X-ray exam of teeth | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
93760 | Cephalic Thermogram | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
76101 | Complex body section x-ray | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D8999 | PR UNS ORTHODONTIC PROCEDURE BY REPORT | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D8010 | PR LTD ORTHODONT TX PRIMARY DENTITION | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D0330 | PR PANORAMIC RADIOGRAPHIC IMAGE | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
21110 | PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
70328 | XR TMJ UNILATERAL | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D2999 | PR UNSPEC RESTORATIVE PROC BY REPORT | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D0230 | PR IO-PERIAPICAL EA ADD RADIOGRPH IMAG | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
21240 | Reconstruction of jaw joint | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
70332 | X-ray exam of jaw joint | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
21243 | Reconstruction of jaw joint | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
21085 | PR IMPRESSION & PREPARATION ORAL SURGICAL SPLINT | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D1510 | Space maintainer fxd unilat | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
70250 | XR Skull < 4 Views | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
76102 | Complex body section x-rays | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D1550 | Recement space maintainer | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
95867 | PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D2940 | PR PROTECTIVE RESTORATION | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
D5899 | Removable prosthodontic proc | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
70260 | XR SKULL 4 VIEWS | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
97762 | C/o for orthotic/prosth use | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
95868 | PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI | HCPCS | Code ranges 21240-21243, 70328-70332, 76.93-76.95, D7873-D7877, 70250-70260, 93760-93762, 95867-95868, 96000-96004, D0210-D0230, D1510-D1550, D2110-D2999, D5000-D5899, D8010-D8999 listed separately
6/30/2004: Code Reference section updated, HCPCS D0330 moved from non-covered to covered, CPT code 70300, 70310, 70320 del... |
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