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15.5k
D0210
PR INTRAORAL-CMPL SER RADIOGRAPH IMAGS
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...
97799
Unlisted physcl med/rehab px
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
90875
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
64555
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
21070
Remove coronoid process
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
76101
Complex body section x-ray
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
97762
C/o for orthotic/prosth use
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
97012
SBT PTA TRACTION, MECHANICAL PER VI
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
97110
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
97112
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
64595
Rev/rmv prph sac/gstr npg/r
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
97530
Therapy procedure using functional activities
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
21085
PR IMPRESSION & PREPARATION ORAL SURGICAL SPLINT
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
21110
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
90876
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
76102
Complex body section x-rays
HCPCS
CPT4 2005 & 2006 revisions added to policy. 1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to co...
97799
Unlisted physcl med/rehab px
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21470
Treat lower jaw fracture
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
1470
Anesthesia for procedure lower leg, foot
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
97112
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21198
Reconstr lwr jaw segment
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21070
Remove coronoid process
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21049
PR EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21196
Reconst lwr jaw w/fixation
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
90875
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
76101
Complex body section x-ray
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21141
PR RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21255
Reconstruct lower jaw bone
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21150
PR RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
97530
Therapy procedure using functional activities
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
70140
XR FACIAL BONES 2 VIEWS
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21110
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
90876
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
70100
XR MANDIBLE 2 VIEWS
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21244
Reconstruction of lower jaw
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21199
Reconstr lwr jaw w/advance
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
97012
SBT PTA TRACTION, MECHANICAL PER VI
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
70110
XR MANDIBLE 4 VIEWS
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21085
PR IMPRESSION & PREPARATION ORAL SURGICAL SPLINT
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21193
Reconst lwr jaw w/o graft
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
70250
XR Skull < 4 Views
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
76102
Complex body section x-rays
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21440
Treat dental ridge fracture
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
64555
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
70260
XR SKULL 4 VIEWS
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
70150
XR FACIAL BONES 3 VIEWS
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
97762
C/o for orthotic/prosth use
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
97110
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
64595
Rev/rmv prph sac/gstr npg/r
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21147
PR RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21025
PR EXCISION BONE MANDIBLE
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
21151
PR RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS
HCPCS
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions 12/19/2007: Coding updated per 2008 CPT/HCPCS revisions 7/28/2008: Code reference section updated: ICD-9 diagnosis 524.64 added to covered. CPT codes 21070, 21085, 21110, 76101, 76102, 97762 added to covered. ICD-9 procedure code 80.29 added to c...
97799
Unlisted physcl med/rehab px
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21470
Treat lower jaw fracture
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
1470
Anesthesia for procedure lower leg, foot
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
97112
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21198
Reconstr lwr jaw segment
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21049
PR EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21196
Reconst lwr jaw w/fixation
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
90875
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
S8262
MANDIB ORTHO REPOSITION DEVICE EACH
CPT
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21141
PR RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21255
Reconstruct lower jaw bone
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21150
PR RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
97530
Therapy procedure using functional activities
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
70140
XR FACIAL BONES 2 VIEWS
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
90876
PR INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
70100
XR MANDIBLE 2 VIEWS
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21244
Reconstruction of lower jaw
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
D7995
Synthetic graft facial bones
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21199
Reconstr lwr jaw w/advance
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
97012
SBT PTA TRACTION, MECHANICAL PER VI
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
70110
XR MANDIBLE 4 VIEWS
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21193
Reconst lwr jaw w/o graft
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
70250
XR Skull < 4 Views
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21440
Treat dental ridge fracture
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
64555
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
70260
XR SKULL 4 VIEWS
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
70150
XR FACIAL BONES 3 VIEWS
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
97110
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
64595
Rev/rmv prph sac/gstr npg/r
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21147
PR RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21025
PR EXCISION BONE MANDIBLE
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
D0290
Skull/facial bone image
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
21151
PR RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS
HCPCS
CPT codes 64555-64595, 90875, 90876, 97012, 97110, 97112, 97530, 97799 added to non-covered. CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, ...
A4630
Repl bat t.e.n.s. own by pt
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
21470
Treat lower jaw fracture
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
1470
Anesthesia for procedure lower leg, foot
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
E0936
CPM device, other than knee
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
E0731
Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient''s skin by layers of fabric)
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
D2934
PR PREFB ESTHET COAT STNLSS STEEL CRWN
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
D5226
PR MANDIBULAR PART DENTURE FLEX BASE
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
21198
Reconstr lwr jaw segment
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
21049
PR EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
21196
Reconst lwr jaw w/fixation
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
S8262
MANDIB ORTHO REPOSITION DEVICE EACH
CPT
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
D5225
PR MAXILLARY PARTIAL DENTURE FLEX BASE
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
21141
PR RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
D2971
PR ADD PROC NEW CROWN XST PART DENTURE
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...
21255
Reconstruct lower jaw bone
HCPCS
CPT codes 21025-21049, 21141-21147, 21150, 21151, 21193-21196, 21198, 21199, 21244-21255, 21440-21470, 70100, 70110, 70140, 70150, 70250, 70260 removed from covered table. ICD-9 procedure codes 76.2, 76.73-76.76, 76.91, 76.92, 80.19 removed from covered table. ICD-9 diagnosis codes 170.9 and 198.5 removed from covered ...