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G0359
Chemotherapy IV one hr initi
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 HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA...
38230
PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC
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 HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA...
G0361
Prolong chemo infuse>8hrs pu
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 HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA...
G0357
IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG
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 HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA...
G0356
HORMONAL ANTINEOPLASTIC
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 HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA...
G0355
CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC
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 HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA...
86826
Hla x-match noncytotoxc addl
HCPCS
Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-cov...
G0267
Bone marrow or psc harvest
CPT
Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-cov...
S2140
Cord blood harvesting for transplantation, allogeneic
HCPCS
Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-cov...
G0265
Cryopresevation Freeze+stora
CPT
Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-cov...
G0266
Thawing + expansion froz cel
CPT
Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-cov...
86825
X-MATCHAHG
HCPCS
Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-cov...
S2142
Cord blood-derived stem-cell transplantation, allogeneic
HCPCS
Policy description updated regarding prevalence of disease and treatment approaches. FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-cov...
86826
Hla x-match noncytotoxc addl
HCPCS
FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
G0267
Bone marrow or psc harvest
CPT
FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
S2140
Cord blood harvesting for transplantation, allogeneic
HCPCS
FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
G0265
Cryopresevation Freeze+stora
CPT
FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
G0266
Thawing + expansion froz cel
CPT
FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
86825
X-MATCHAHG
HCPCS
FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
S2142
Cord blood-derived stem-cell transplantation, allogeneic
HCPCS
FEP verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes.
86826
Hla x-match noncytotoxc addl
HCPCS
Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
G0267
Bone marrow or psc harvest
CPT
Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
S2140
Cord blood harvesting for transplantation, allogeneic
HCPCS
Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
G0265
Cryopresevation Freeze+stora
CPT
Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
G0266
Thawing + expansion froz cel
CPT
Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
86825
X-MATCHAHG
HCPCS
Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
S2142
Cord blood-derived stem-cell transplantation, allogeneic
HCPCS
Added new CPT codes 86825 and 86826. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. Added HCPCS S2140 and S2142 to the non-covered table. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes.
38241
Transplt autol hct/donor
HCPCS
03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and rem...
G0363
IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS
HCPCS
03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and rem...
38240
Transplt allo hct/donor
HCPCS
03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and rem...
38242
Transplt allo lymphocytes
HCPCS
03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and rem...
96445
Chemotherapy, intracavitary
HCPCS
03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and rem...
96446
PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH
HCPCS
03/10/2014: Policy reviewed; description updated. Policy statement unchanged. 12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and rem...
38241
Transplt autol hct/donor
HCPCS
12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cr...
G0363
IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS
HCPCS
12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cr...
38240
Transplt allo hct/donor
HCPCS
12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cr...
38242
Transplt allo lymphocytes
HCPCS
12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cr...
96445
Chemotherapy, intracavitary
HCPCS
12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cr...
96446
PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH
HCPCS
12/19/2014: Policy reviewed; description updated. Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cr...
38241
Transplt autol hct/donor
HCPCS
Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE ...
G0363
IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS
HCPCS
Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE ...
38240
Transplt allo hct/donor
HCPCS
Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE ...
38242
Transplt allo lymphocytes
HCPCS
Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE ...
96445
Chemotherapy, intracavitary
HCPCS
Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE ...
96446
PR CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH
HCPCS
Policy statement unchanged. 08/26/2015: Code Reference section updated to add ICD-10 codes, updated the code descriptions for 38240, 38241, and 38242; removed deleted HCPCS code G0363, and removed deleted code CPT 96445 and replaced with CPT code 96446. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.23 CODE ...
J0881
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)
HCPCS
Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl ...
J0885
INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
HCPCS
Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl ...
96372
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR
HCPCS
Equivalent doses may be provided over other approved time periods. - Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl ...
J0881
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)
HCPCS
- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four...
J0885
INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
HCPCS
- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four...
96372
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR
HCPCS
- Maintenance of ESA therapy = starting dose; if hemoglobin level remains below 10g/dL (or hematocrit is < 30%) four weeks after initiation of therapy and the rise in hemoglobin is > 1g/dL (hematocrit > 3%) - For patients whose hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline over four...
J0881
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)
HCPCS
Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treat...
J0885
INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
HCPCS
Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treat...
96372
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR
HCPCS
Continued use of the drug is not reasonable and necessary if hemoglobin rises < 1g/dl (hematocrit rise < 3%), compared to pretreatment baseline by eight weeks of treatment - Continued administration of the drug is not reasonable and necessary if rapid rise in hemoglobin > 1g/dl (hematocrit > 3%) over two weeks of treat...
85025
TTH CBC W/AUTO DIFF-SP
HCPCS
- Three-digit number reported (such as 31.2) = 31.2 - Two-digit number reported (such as 4.5) = 04.5 - Two-digit whole number reported (such as 28) = 28.0 - Single decimal position reported (such as .9) = 00.9 - One-digit whole number reported (such as 7) = 07.0 - Test result reported as 2-digits and 2 decimal places (...
85027
HEMOGRAM
HCPCS
- Three-digit number reported (such as 31.2) = 31.2 - Two-digit number reported (such as 4.5) = 04.5 - Two-digit whole number reported (such as 28) = 28.0 - Single decimal position reported (such as .9) = 00.9 - One-digit whole number reported (such as 7) = 07.0 - Test result reported as 2-digits and 2 decimal places (...
0264
IV Therapy - IV Therapy/Supplies
RC
Lauren took her acetaminophen orally so the concept ID 4132161 (“Oral”) is used.| |LOT_NUMBER||NULL||An identifier assigned to a particular quantity or lot of Drug product from the manufacturer. This information is rarely captured.| |PROVIDER_ID||NULL||If the drug record has a prescribing Provider listed, the ID for th...
0264
IV Therapy - IV Therapy/Supplies
RC
In that case this contains the PROVIDER_ID from the PROVIDER table.| |VISIT_OCCURRENCE_ ID||509||A foreign key to the VISIT_OCCURRENCE table during which the Drug was prescribed.| |VISIT_DETAIL_ID||NULL||A foreign key to the VISIT_DETAIL table during which the Drug was prescribed.| |DRUG_SOURCE_ VALUE||69842087651||Thi...
0443
Speech-language Pathology - Group
RC
does it come from an insurance claim, EHR order, etc. For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.| |MODIFIER_CONCEPT_ ID||0||This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a...
4127
CATH SWN/GZ VIP 5FR 110CM
CDM
does it come from an insurance claim, EHR order, etc. For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.| |MODIFIER_CONCEPT_ ID||0||This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a...
0275
PACEMAKER, SINGLE CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)
RC
does it come from an insurance claim, EHR order, etc. For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.| |MODIFIER_CONCEPT_ ID||0||This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a...
0443
Speech-language Pathology - Group
RC
For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.| |MODIFIER_CONCEPT_ ID||0||This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the con...
4127
CATH SWN/GZ VIP 5FR 110CM
CDM
For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.| |MODIFIER_CONCEPT_ ID||0||This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the con...
0275
PACEMAKER, SINGLE CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)
RC
For this example the concept ID 38000275 (“EHR order list entry”) is used as the procedure record is from an EHR record.| |MODIFIER_CONCEPT_ ID||0||This is meant for a concept ID representing the modifier on the procedure. For example, if the record indicated that a CPT4 procedure was performed bilaterally then the con...
0443
Speech-language Pathology - Group
RC
For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.| |QUANTITY||0||The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.| |PROVIDER_ID||NULL||If the Procedu...
4127
CATH SWN/GZ VIP 5FR 110CM
CDM
For example, if the record indicated that a CPT4 procedure was performed bilaterally then the concept ID 42739579 (“Bilateral procedure”) would be used.| |QUANTITY||0||The quantity of Procedures ordered or administered. A missing Quantity, the numbers 0 and 1 all mean the same thing.| |PROVIDER_ID||NULL||If the Procedu...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
CMS is considering phasing out HCPCS. There are 3 levels within HCPCS: HCPCS Level 1 Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index). HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable ...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
There are 3 levels within HCPCS: HCPCS Level 1 Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index). HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCP...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCPCS Level 3 Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on Decemb...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
HCPCS Level 3 Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003. Current Procedural Terminology (CPT) is an outpatient medical coding codeset that is copy-written by the American M...
1590
New Technology - Level 39
APC
JO - Digestive and Liver Disease. JF - Digestive and Liver Disease. SN - 1590-8658. ER - ... ICD-10-PCS Code 0DVH7DZ - Restriction of Cecum with Intraluminal Device, Via Natural or Artificial Opening - Codify by AAPC ICD-10-PCS code 0DVH7DZ for Restriction of Cecum with Intraluminal Device, Via Natural or Artificial Op...
1590
New Technology - Level 39
APC
JF - Digestive and Liver Disease. SN - 1590-8658. ER - ... ICD-10-PCS Code 0DVH7DZ - Restriction of Cecum with Intraluminal Device, Via Natural or Artificial Opening - Codify by AAPC ICD-10-PCS code 0DVH7DZ for Restriction of Cecum with Intraluminal Device, Via Natural or Artificial Opening is a medical classification ...
G0358
IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG
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...
G0360
Each additional hr 1-8 hrs
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...
G0363
IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS
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...
J9000
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
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...
G0364
HC BONE MARROW ASPIRATE & BIOPSY
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...
G0362
Each add sequential infusion
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...
J9999
Not otherwise classified, antineoplastic drugs
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...
G0359
Chemotherapy IV one hr initi
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...
38230
PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC
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...
G0361
Prolong chemo infuse>8hrs pu
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...
G0357
IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG
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...
G0356
HORMONAL ANTINEOPLASTIC
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...
G0355
CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC
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...
G0358
IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0360
Each additional hr 1-8 hrs
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0363
IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
J9000
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0364
HC BONE MARROW ASPIRATE & BIOPSY
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0362
Each add sequential infusion
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
J9999
Not otherwise classified, antineoplastic drugs
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0359
Chemotherapy IV one hr initi
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
38230
PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0361
Prolong chemo infuse>8hrs pu
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0357
IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0356
HORMONAL ANTINEOPLASTIC
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0355
CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01...
G0358
IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG
HCPCS
3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “H...
G0360
Each additional hr 1-8 hrs
HCPCS
3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.20 per approval by Medical Policy Advisory Committee (MPAC) 7/19/2004: Code Reference section completed 11/18/2004: Reviewed by MPAC, “H...