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36511
PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of...
36513
PR THERAPEUTIC APHERESIS PLATELETS
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of...
36512
PR THERAPEUTIC APHERESIS RED BLOOD CELLS
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of...
36521
USE 36516
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of...
36520
SEE 36511-36512
HCPCS
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC) 11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC 5/1999: MPAC reviewed policies; updated, combined and renamed 12/1999: Interim revision; new FDA-approved indication added for some stages of...
36522
PR PHOTOPHERESIS EXTRACORPOREAL
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 7...
S2120
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 7...
86960
HC VOL REDUC BLD/PRD EA UN
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 7...
36516
PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 7...
36515
Apheresis adsorp/reinfuse
HCPCS
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 7...
36522
PR PHOTOPHERESIS EXTRACORPOREAL
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0,...
S2120
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0,...
86960
HC VOL REDUC BLD/PRD EA UN
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0,...
36516
PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0,...
36515
Apheresis adsorp/reinfuse
HCPCS
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0,...
88145
Cytopath, c/v, thin lyr sel
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
G0148
Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
87620
Hpv dna dir probe
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88174
Cytopath c/v auto in fluid
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88148
Cytopath c/v auto rescreen
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
G0143
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88153
Cytopath c/v redo
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
87621
Hpv dna amp probe
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
87622
Hpv dna quant
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
G0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88147
Cytopath c/v automated
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
G0124
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88165
Cytopath tbs c/v redo
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
P3000
Screen pap by tech w md supv
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
G0123
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, SCREENING BY CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
G0145
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
G0147
Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
P3001
Screening pap smear by phys
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88164
HC CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; MANUAL SCREENING
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88144
Cytopath, c/v, thin lyr redo
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88175
PAP
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
88145
Cytopath, c/v, thin lyr sel
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
G0148
Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
87620
Hpv dna dir probe
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
88174
Cytopath c/v auto in fluid
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
88148
Cytopath c/v auto rescreen
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
G0143
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
88153
Cytopath c/v redo
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
87621
Hpv dna amp probe
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
87622
Hpv dna quant
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
G0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
88147
Cytopath c/v automated
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
G0124
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
88165
Cytopath tbs c/v redo
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
P3000
Screen pap by tech w md supv
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
G0123
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, SCREENING BY CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
G0145
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
G0147
Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
P3001
Screening pap smear by phys
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
88164
HC CYTOPATHOLOGY, SLIDES, CERVICAL OR VAGINAL; MANUAL SCREENING
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
88144
Cytopath, c/v, thin lyr redo
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
88175
PAP
HCPCS
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC) 8/21/2002: Policy Guidelines revised, CPT codes 88147, 88148, 88153, 88164, 88165 deleted, HCPCS P3000-P3001 deleted, HCPCS G0123-G0124, G0143-G0145 added 10/17/2005: Code reference section updated; CPT-4: 87620, 87621, 87622, 88147, 88148 added...
87622
Hpv dna quant
HCPCS
Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; p...
P3000
Screen pap by tech w md supv
HCPCS
Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; p...
88174
Cytopath c/v auto in fluid
HCPCS
Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; p...
P3001
Screening pap smear by phys
HCPCS
Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; p...
88175
PAP
HCPCS
Code reference section udpated. CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; p...
87622
Hpv dna quant
HCPCS
CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The f...
P3000
Screen pap by tech w md supv
HCPCS
CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The f...
88174
Cytopath c/v auto in fluid
HCPCS
CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The f...
P3001
Screening pap smear by phys
HCPCS
CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The f...
88175
PAP
HCPCS
CPT codes 88174 and 88175; HCPCS P3000 and P3001 added to policy 11/14/2006: Code Reference section updated: CPT code 87622 deleted. 8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The f...
87622
Hpv dna quant
HCPCS
8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and ...
G0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
HCPCS
8/28/2007: In situ hybridization (ISH) for HPV testing is considered investigational. 7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and ...
87622
Hpv dna quant
HCPCS
7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description o...
G0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
HCPCS
7/22/2008: Policy reviewed, no changes 09/10/2010: Policy reviewed; policy statement unchanged. The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description o...
87622
Hpv dna quant
HCPCS
The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. Policy title changed from "Monolayer...
G0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
HCPCS
The following ICD-9 codes were added to the Covered Codes Table: 795.00-795.04, 795.06, 795.08, 795.10, 795.11, 795.71, 796.9, V73.81 and V72.3. CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. Policy title changed from "Monolayer...
87622
Hpv dna quant
HCPCS
CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. Policy title changed from "Monolayer Slide Preparation and AutoSlide Reading Systems for Cervical Cancer Screening" to "Cervical Cancer Screening Technologies with Pap and HPV." 05/...
G0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
HCPCS
CPT code 87622 was moved from non-covered to covered. Revised the description of HCPCS code G0141. 12/30/2010: Policy description updated. Policy title changed from "Monolayer Slide Preparation and AutoSlide Reading Systems for Cervical Cancer Screening" to "Cervical Cancer Screening Technologies with Pap and HPV." 05/...
E0751
PULSE GENERATOR OR RECEIVER
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
95972
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
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...
63690
-1
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...
1999
ANESTHESIOLOGY GROUP
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
95970
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
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...
E0753
NEUROSTIMUL ELECTRODES/LEADS
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
95971
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
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...
63685
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
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...
63691
-1
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...
E0754
PT PROGRAMMER W/IMPL PROG NEUROSTIM PULSE GEN
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
E0752
IMPLANTABLE NEUROSTIMULATOR ELECTRODE EACH
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
63660
Revise/Remove Neuroelectrode
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...
95973
Analyze neurostim complex
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...
E0751
PULSE GENERATOR OR RECEIVER
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
95972
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
63690
-1
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
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. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
95970
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
E0753
NEUROSTIMUL ELECTRODES/LEADS
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
95971
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
63685
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
63691
-1
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
E0754
PT PROGRAMMER W/IMPL PROG NEUROSTIM PULSE GEN
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
E0752
IMPLANTABLE NEUROSTIMULATOR ELECTRODE EACH
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...
63660
Revise/Remove Neuroelectrode
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1993: Approved by Medical Policy Advisory Committee (MPAC) 3/2001: Policy reviewed; Hyperlinks inserted under Policy, Managed Care Requirements deleted, Sources updated 2/15/2002: I...