code stringlengths 4 12 | description stringlengths 2 264 | codetype stringclasses 8
values | context stringlengths 160 15.5k |
|---|---|---|---|
38210 | T-cell depletion of harvest | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38212 | Rbc depletion of harvest | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38205 | PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0362 | Each add sequential infusion | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0357 | IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0356 | HORMONAL ANTINEOPLASTIC | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0267 | Bone marrow or psc harvest | CPT | ICD9 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc... |
G0266 | Thawing + expansion froz cel | CPT | ICD9 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc... |
G0265 | Cryopresevation Freeze+stora | CPT | ICD9 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc... |
G0267 | Bone marrow or psc harvest | CPT | ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ... |
G0266 | Thawing + expansion froz cel | CPT | ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ... |
G0265 | Cryopresevation Freeze+stora | CPT | ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ... |
G0279 | TOMOSYNTHESIS MAMMO DX Injectable Drugs Not on Fee Schedule | HCPCS | 09/23/2014: Policy reviewed; description revised. Policy statement unchanged. 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. |
77061 | HC DIGITAL BREAST TOMOSYNTHESIS UNILATERAL | HCPCS | 09/23/2014: Policy reviewed; description revised. Policy statement unchanged. 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. |
77062 | MM MAMMO TOMOSYNTHESIS BILATERAL | HCPCS | 09/23/2014: Policy reviewed; description revised. Policy statement unchanged. 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. |
77063 | Screening 3D breast mammography | HCPCS | 09/23/2014: Policy reviewed; description revised. Policy statement unchanged. 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. |
G0279 | TOMOSYNTHESIS MAMMO DX Injectable Drugs Not on Fee Schedule | HCPCS | Policy statement unchanged. 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. 10/22/2015: Policy description updated regarding tomosynthesis systems. |
77061 | HC DIGITAL BREAST TOMOSYNTHESIS UNILATERAL | HCPCS | Policy statement unchanged. 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. 10/22/2015: Policy description updated regarding tomosynthesis systems. |
77062 | MM MAMMO TOMOSYNTHESIS BILATERAL | HCPCS | Policy statement unchanged. 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. 10/22/2015: Policy description updated regarding tomosynthesis systems. |
77063 | Screening 3D breast mammography | HCPCS | Policy statement unchanged. 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. 10/22/2015: Policy description updated regarding tomosynthesis systems. |
G0279 | TOMOSYNTHESIS MAMMO DX Injectable Drugs Not on Fee Schedule | HCPCS | 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. 10/22/2015: Policy description updated regarding tomosynthesis systems. Policy statement unchanged. |
77061 | HC DIGITAL BREAST TOMOSYNTHESIS UNILATERAL | HCPCS | 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. 10/22/2015: Policy description updated regarding tomosynthesis systems. Policy statement unchanged. |
77062 | MM MAMMO TOMOSYNTHESIS BILATERAL | HCPCS | 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. 10/22/2015: Policy description updated regarding tomosynthesis systems. Policy statement unchanged. |
77063 | Screening 3D breast mammography | HCPCS | 02/23/2015: Added HCPCS code G0279 to the Code Reference section. 04/27/2015: Added CPT codes 77061, 77062, and 77063 to the Code Reference section. 07/13/2015: Code Reference section updated for ICD-10. 10/22/2015: Policy description updated regarding tomosynthesis systems. Policy statement unchanged. |
0204 | Psych/Detox | RC | 01/20/2016: Policy description updated. Policy statement unchanged. 05/31/2016: Policy number added. SOURCE(S)Blue Cross Blue Shield Association policy # 6.01.53
This may not be a comprehensive list of procedure codes applicable to this policy. Unlisted diagnostic radiographic procedure
Digital breast tomosynthesis; un... |
0206 | HC INTERMEDIATE ROOM AND CARE ISOLATION | RC | 01/20/2016: Policy description updated. Policy statement unchanged. 05/31/2016: Policy number added. SOURCE(S)Blue Cross Blue Shield Association policy # 6.01.53
This may not be a comprehensive list of procedure codes applicable to this policy. Unlisted diagnostic radiographic procedure
Digital breast tomosynthesis; un... |
0204 | Psych/Detox | RC | Policy statement unchanged. 05/31/2016: Policy number added. SOURCE(S)Blue Cross Blue Shield Association policy # 6.01.53
This may not be a comprehensive list of procedure codes applicable to this policy. Unlisted diagnostic radiographic procedure
Digital breast tomosynthesis; unilateral
Digital breast tomosynthesis; b... |
0206 | HC INTERMEDIATE ROOM AND CARE ISOLATION | RC | Policy statement unchanged. 05/31/2016: Policy number added. SOURCE(S)Blue Cross Blue Shield Association policy # 6.01.53
This may not be a comprehensive list of procedure codes applicable to this policy. Unlisted diagnostic radiographic procedure
Digital breast tomosynthesis; unilateral
Digital breast tomosynthesis; b... |
0204 | Psych/Detox | RC | 05/31/2016: Policy number added. SOURCE(S)Blue Cross Blue Shield Association policy # 6.01.53
This may not be a comprehensive list of procedure codes applicable to this policy. Unlisted diagnostic radiographic procedure
Digital breast tomosynthesis; unilateral
Digital breast tomosynthesis; bilateral
Screening digital b... |
0206 | HC INTERMEDIATE ROOM AND CARE ISOLATION | RC | 05/31/2016: Policy number added. SOURCE(S)Blue Cross Blue Shield Association policy # 6.01.53
This may not be a comprehensive list of procedure codes applicable to this policy. Unlisted diagnostic radiographic procedure
Digital breast tomosynthesis; unilateral
Digital breast tomosynthesis; bilateral
Screening digital b... |
44799 | Unlisted px small intestine | HCPCS | 04/24/2014: Policy reviewed; description updated regarding FDA approval of devices. Policy statement unchanged. 12/31/2014: Code Reference section updated to revise the description of the following CPT code: 44799. Added the following new 2015 HCPCS code: G6021. 04/01/2015: Policy description updated regarding devices. |
44799 | Unlisted px small intestine | HCPCS | Policy statement unchanged. 12/31/2014: Code Reference section updated to revise the description of the following CPT code: 44799. Added the following new 2015 HCPCS code: G6021. 04/01/2015: Policy description updated regarding devices. Policy statements unchanged. |
44799 | Unlisted px small intestine | HCPCS | 12/31/2014: Code Reference section updated to revise the description of the following CPT code: 44799. Added the following new 2015 HCPCS code: G6021. 04/01/2015: Policy description updated regarding devices. Policy statements unchanged. Policy guidelines updated to revise the definition of investigative. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | HCPCS Level III contains alphanumeric codes that are assigned
by Medicaid state agencies to identify additional items
and services not included in levels I or II. These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three ... |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three levels, with the WA - ZY range used for locally
assigned procedure modifiers. - Health Insurance Portability &
Accountability Act (HIPAA) – A law passed
in 1996 wh... |
1999 | ANESTHESIOLOGY GROUP | CPT | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity appr... |
43644 | PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
1999 | ANESTHESIOLOGY GROUP | CPT | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
S2082 | Lap adjustable gastric band | CPT | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
43633 | Removal of stomach partial | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
43847 | PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
43645 | PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
S2085 | Laparoscop gastric bypass | CPT | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
43848 | Revision gastroplasty | HCPCS | POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Inter... |
43644 | PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
S2082 | Lap adjustable gastric band | CPT | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
43633 | Removal of stomach partial | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
43847 | PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
43645 | PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
S2085 | Laparoscop gastric bypass | CPT | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
43848 | Revision gastroplasty | HCPCS | See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS... |
43644 | PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
S2082 | Lap adjustable gastric band | CPT | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
43633 | Removal of stomach partial | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
43847 | PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
43645 | PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
S2085 | Laparoscop gastric bypass | CPT | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
43848 | Revision gastroplasty | HCPCS | 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered... |
43644 | PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
S2082 | Lap adjustable gastric band | CPT | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
43847 | PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
43645 | PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
S2085 | Laparoscop gastric bypass | CPT | All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources up... |
S2083 | PR ADJUSTMENT GASTRIC BAND | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopa... |
43774 | PR LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopa... |
43888 | PR GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopa... |
43770 | PR LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopa... |
43886 | Revise gastric port open | HCPCS | CPT codes 43770-43774, 43886-43888, HCPCS code S2083, ICD-9 procedure codes 44.95, 44.97, 44.98 moved to covered
7/30/2010: Policy description updated to include detailed descriptions of gastric restrictive procedures and malabsorptive procedures. Policy statement section updated to include open or laparoscopic biliopa... |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | FEP prior authorization requirement and FDA language added to policy exception section. Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to c... |
S9452 | Nutrition class | HCPCS | FEP prior authorization requirement and FDA language added to policy exception section. Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to c... |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | FEP prior authorization requirement and FDA language added to policy exception section. Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to c... |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | FEP prior authorization requirement and FDA language added to policy exception section. Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to c... |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added ... |
S9452 | Nutrition class | HCPCS | Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added ... |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added ... |
43846 | PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | HCPCS | Policy guidelines section updated to include detailed information regarding patient selection criteria and BMI calculation. Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added ... |
43845 | PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | HCPCS | Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to th... |
S9452 | Nutrition class | HCPCS | Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to th... |
43659 | HC UNLISTED LAPAROSCOPE PROC STOM | HCPCS | Code reference section updated: Description revised for CPT codes 43659 and 43846. CPT code 43845 added to covered table, ICD-9 diagnosis code 997.4 added to covered table, HCPCS code S9452 added to covered table. 10/19/2010: Annual ICD-9 code update: V85.4 deleted/expanded to the fifth digit. Added V85.41-V85.45 to th... |
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