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|---|---|---|---|
G0007
|
PT DEMAND RECORD/30 DA; MD REVIEW &
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
93270
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
33999
|
Unlisted px cardiac surgery
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
93014
|
Report on transmitted ecg
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
G0004
|
PT DEMAND RECORD/30 DA; INCL TRANSM
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
93012
|
Transmission of ecg
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
93271
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
93272
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
G0015
|
Post Symptom Ecg Tracing
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. 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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed.
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
G0007
|
PT DEMAND RECORD/30 DA; MD REVIEW &
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
93270
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
33999
|
Unlisted px cardiac surgery
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
93014
|
Report on transmitted ecg
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
G0004
|
PT DEMAND RECORD/30 DA; INCL TRANSM
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
93012
|
Transmission of ecg
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
93271
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
93272
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
G0015
|
Post Symptom Ecg Tracing
|
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 must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. 2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
G0007
|
PT DEMAND RECORD/30 DA; MD REVIEW &
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
93228
|
TELEMETRY MONITOR UP TO 30 DAYS
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
93270
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
33999
|
Unlisted px cardiac surgery
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
93014
|
Report on transmitted ecg
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
G0004
|
PT DEMAND RECORD/30 DA; INCL TRANSM
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
93012
|
Transmission of ecg
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
93271
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
93272
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
G0015
|
Post Symptom Ecg Tracing
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
93229
|
Remote 30 day ecg tech supp
|
HCPCS
|
2/1999: Implantable Continuous "Memory Loop" Devices policy approved by Medical Policy Advisory Committee (MPAC), CPT 33999 added
5/1999: MPAC expanded and renamed policy to include all Ambulatory Event Monitors
1/23/2002: Prior authorization deleted
2/15/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section updated, CPT 93012, 93014 added
8/4/2003: Code Reference section updated, HCPCS G0004-G0007, G00015 deleted
10/21/2004: Code Reference section updated, CPT 33999, 93012, 93014 deleted, CPT 93270, 93271, 93272 description revised, ICD-9 procedure code 86.05, 86.09 description revised, HCPCS G0015 deleted
10/25/2005: Policy clarified and re-titled
03/07/2006: Coding updated. HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table.
|
93229
|
Remote 30 day ecg tech supp
|
HCPCS
|
HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table. Also identified HCPCS Codes S0345, S0346 & S0347 were deleted as of 12/31/2009.
|
93228
|
TELEMETRY MONITOR UP TO 30 DAYS
|
HCPCS
|
HCPCS 2006 revisions added to policy
09/12/2006: Coding updated. ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table. Also identified HCPCS Codes S0345, S0346 & S0347 were deleted as of 12/31/2009.
|
93229
|
Remote 30 day ecg tech supp
|
HCPCS
|
ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table. Also identified HCPCS Codes S0345, S0346 & S0347 were deleted as of 12/31/2009. 10/21/2010: Policy reviewed; no changes.
|
93228
|
TELEMETRY MONITOR UP TO 30 DAYS
|
HCPCS
|
ICD9 2006 revisions added to policy
1/3/2007: Policy reviewed, policy section clarified
5/11/2007: Policy reviewed. Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table. Also identified HCPCS Codes S0345, S0346 & S0347 were deleted as of 12/31/2009. 10/21/2010: Policy reviewed; no changes.
|
93229
|
Remote 30 day ecg tech supp
|
HCPCS
|
Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table. Also identified HCPCS Codes S0345, S0346 & S0347 were deleted as of 12/31/2009. 10/21/2010: Policy reviewed; no changes. 03/10/2011: Added ICD-9 code 785.0 to the Covered Codes table.
|
93228
|
TELEMETRY MONITOR UP TO 30 DAYS
|
HCPCS
|
Policy section updated; no change to policy statements
12/24/2008: Coding reference section updated per the 2009 CPT/HCPCS revisions
5/14/2009: Outpatient cardiac telemetry (MCOT) changed from "investigational" to "not medically necessary"
04/12/2010: Description section revised with other outpatient cardiac telemetry systems. Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table. Also identified HCPCS Codes S0345, S0346 & S0347 were deleted as of 12/31/2009. 10/21/2010: Policy reviewed; no changes. 03/10/2011: Added ICD-9 code 785.0 to the Covered Codes table.
|
93229
|
Remote 30 day ecg tech supp
|
HCPCS
|
Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table. Also identified HCPCS Codes S0345, S0346 & S0347 were deleted as of 12/31/2009. 10/21/2010: Policy reviewed; no changes. 03/10/2011: Added ICD-9 code 785.0 to the Covered Codes table. 01/17/2012: Added the following policy statement: The use of auto-activated external ambulatory event monitors may be considered medically necessary in patients treated for atrial fibrillation to monitor for asymptomatic episodes in order to evaluate treatment response.
|
93228
|
TELEMETRY MONITOR UP TO 30 DAYS
|
HCPCS
|
Coding Section revised to add CPT Codes 93228 and 93229 and ICD-9 Diagnosis codes 427.0, 427.1, 427.2, 427.31, 427.32, 427.41, 427.42, 427.61, 427.69 and 427.81 to the Covered Codes Table. Also identified HCPCS Codes S0345, S0346 & S0347 were deleted as of 12/31/2009. 10/21/2010: Policy reviewed; no changes. 03/10/2011: Added ICD-9 code 785.0 to the Covered Codes table. 01/17/2012: Added the following policy statement: The use of auto-activated external ambulatory event monitors may be considered medically necessary in patients treated for atrial fibrillation to monitor for asymptomatic episodes in order to evaluate treatment response.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
- Ophthalmic Technology Assessment Committee Cornea Panel American Academy of Ophthalmology. Corneal topography. Ophthalmology 1999; 106(8-Jan):1628-38. |CPT||92025||Computerized corneal topography, unilateral or bilateral, with interpretation and report|
|92002–92014||General ophthalmological services|
|ICD-9 Procedure||95.02||Comprehensive eye examination|
|95.09||Eye examination, not otherwise specified|
|ICD-9 Diagnosis||Not medically necessary for all diagnoses|
|ICD-10-CM (effective 10/01/15)||Not medically necessary for all diagnoses|
|H16.001-H16.9||Keratitis code range|
|H17.00-H17.9||Corneal scars and opacities code range|
|H18.001-H18.9||Other disorders of cornea code range|
|ICD-10-PCS (effective 10/01/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this examination.|
|08J0XZZ, 08J1XZZ||Eye examination, code by body part (right eye or left eye)|
|Type of Service||Ophthalmology|
|Place of Service||Physician’s Office|
|11/1/97||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature review; new review date only|
|10/09/03||Replace policy||Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled|
|10/10/2006||Replace policy||Policy updated with literature review.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
Corneal topography. Ophthalmology 1999; 106(8-Jan):1628-38. |CPT||92025||Computerized corneal topography, unilateral or bilateral, with interpretation and report|
|92002–92014||General ophthalmological services|
|ICD-9 Procedure||95.02||Comprehensive eye examination|
|95.09||Eye examination, not otherwise specified|
|ICD-9 Diagnosis||Not medically necessary for all diagnoses|
|ICD-10-CM (effective 10/01/15)||Not medically necessary for all diagnoses|
|H16.001-H16.9||Keratitis code range|
|H17.00-H17.9||Corneal scars and opacities code range|
|H18.001-H18.9||Other disorders of cornea code range|
|ICD-10-PCS (effective 10/01/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this examination.|
|08J0XZZ, 08J1XZZ||Eye examination, code by body part (right eye or left eye)|
|Type of Service||Ophthalmology|
|Place of Service||Physician’s Office|
|11/1/97||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature review; new review date only|
|10/09/03||Replace policy||Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled|
|10/10/2006||Replace policy||Policy updated with literature review. Policy statement revised.|
|12/13/07||Replace Policy||Policy updated with literature review; reference 3 added; policy statement unchanged.|
|04/24/09||Replace policy||Policy updated with literature review through January 2009; policy statement changed to not medically necessary.|
|04/08/10||Replace policy||Policy updated with literature review through February 2010; reference 3 added; policy statement unchanged|
|4/14/11||Replace policy||Policy updated with literature review through February 2011; policy statement unchanged|
|04/12/12||Replace policy||Policy updated with literature review through February 2012; policy statement unchanged|
|04/11/13||Replace policy||Policy updated with literature review through March 13, 2013; reference 4 added; policy statement unchanged|
|4/10/14||Replace policy||Policy updated with literature review through March 3, 2014; policy statement unchanged|
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
Ophthalmology 1999; 106(8-Jan):1628-38. |CPT||92025||Computerized corneal topography, unilateral or bilateral, with interpretation and report|
|92002–92014||General ophthalmological services|
|ICD-9 Procedure||95.02||Comprehensive eye examination|
|95.09||Eye examination, not otherwise specified|
|ICD-9 Diagnosis||Not medically necessary for all diagnoses|
|ICD-10-CM (effective 10/01/15)||Not medically necessary for all diagnoses|
|H16.001-H16.9||Keratitis code range|
|H17.00-H17.9||Corneal scars and opacities code range|
|H18.001-H18.9||Other disorders of cornea code range|
|ICD-10-PCS (effective 10/01/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for this examination.|
|08J0XZZ, 08J1XZZ||Eye examination, code by body part (right eye or left eye)|
|Type of Service||Ophthalmology|
|Place of Service||Physician’s Office|
|11/1/97||Add to Vision section||New policy|
|7/12/02||Replace policy||Policy reviewed without literature review; new review date only|
|10/09/03||Replace policy||Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled|
|10/10/2006||Replace policy||Policy updated with literature review. Policy statement revised.|
|12/13/07||Replace Policy||Policy updated with literature review; reference 3 added; policy statement unchanged.|
|04/24/09||Replace policy||Policy updated with literature review through January 2009; policy statement changed to not medically necessary.|
|04/08/10||Replace policy||Policy updated with literature review through February 2010; reference 3 added; policy statement unchanged|
|4/14/11||Replace policy||Policy updated with literature review through February 2011; policy statement unchanged|
|04/12/12||Replace policy||Policy updated with literature review through February 2012; policy statement unchanged|
|04/11/13||Replace policy||Policy updated with literature review through March 13, 2013; reference 4 added; policy statement unchanged|
|4/10/14||Replace policy||Policy updated with literature review through March 3, 2014; policy statement unchanged|
|
00216
|
ANESTH HEAD VESSEL SURGERY
|
CPT
|
For the procedure, we’d code 23140 for “excision or curretage of bone cyst or benign tumor, humerus; with autograft (includes obtaining the graft).” Since the procedure was completed but not fully successful, we’d add the -52 modifier, for reduced services, to the code, and we’d end up with 23140-52. Physical Status Modifier (for Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1.
|
00216
|
ANESTH HEAD VESSEL SURGERY
|
CPT
|
These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day.
|
00216
|
ANESTH HEAD VESSEL SURGERY
|
CPT
|
Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. Note that there may be some overlap or contradiction with the set of HCPCS modifiers, which we’ll cover in more depth later on.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
Understanding and recognizing the changes is imperative and can be done through crosswalking. What is ASA Crosswalk? All anesthesia services are billed with the CPT codes ranging from 00100-01999, which are crosswalked to surgical codes. The American Society of Anesthesiologists offers their service of Find-A-Code using which crosswalking of anesthesia is made easier. Using Find-A-Code you can crosswalk from CPT Anesthesia codes to Surgery and Procedure Codes and vice versa.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
Understanding and recognizing the changes is imperative and can be done through crosswalking. What is ASA Crosswalk? All anesthesia services are billed with the CPT codes ranging from 00100-01999, which are crosswalked to surgical codes. The American Society of Anesthesiologists offers their service of Find-A-Code using which crosswalking of anesthesia is made easier. Using Find-A-Code you can crosswalk from CPT Anesthesia codes to Surgery and Procedure Codes and vice versa.
|
01999
|
Unlisted anesth procedure
|
CPT
|
Understanding and recognizing the changes is imperative and can be done through crosswalking. What is ASA Crosswalk? All anesthesia services are billed with the CPT codes ranging from 00100-01999, which are crosswalked to surgical codes. The American Society of Anesthesiologists offers their service of Find-A-Code using which crosswalking of anesthesia is made easier. Using Find-A-Code you can crosswalk from CPT Anesthesia codes to Surgery and Procedure Codes and vice versa.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
All anesthesia services are billed with the CPT codes ranging from 00100-01999, which are crosswalked to surgical codes. The American Society of Anesthesiologists offers their service of Find-A-Code using which crosswalking of anesthesia is made easier. Using Find-A-Code you can crosswalk from CPT Anesthesia codes to Surgery and Procedure Codes and vice versa. You can also see CMS Base units and ASA Base Units. Crosswalking between ICD-9 and ICD-10
In recent years, the real crosswalking challenge was the transition from ICD-9-CM to ICD-10-CM.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
All anesthesia services are billed with the CPT codes ranging from 00100-01999, which are crosswalked to surgical codes. The American Society of Anesthesiologists offers their service of Find-A-Code using which crosswalking of anesthesia is made easier. Using Find-A-Code you can crosswalk from CPT Anesthesia codes to Surgery and Procedure Codes and vice versa. You can also see CMS Base units and ASA Base Units. Crosswalking between ICD-9 and ICD-10
In recent years, the real crosswalking challenge was the transition from ICD-9-CM to ICD-10-CM.
|
01999
|
Unlisted anesth procedure
|
CPT
|
All anesthesia services are billed with the CPT codes ranging from 00100-01999, which are crosswalked to surgical codes. The American Society of Anesthesiologists offers their service of Find-A-Code using which crosswalking of anesthesia is made easier. Using Find-A-Code you can crosswalk from CPT Anesthesia codes to Surgery and Procedure Codes and vice versa. You can also see CMS Base units and ASA Base Units. Crosswalking between ICD-9 and ICD-10
In recent years, the real crosswalking challenge was the transition from ICD-9-CM to ICD-10-CM.
|
A5120
|
Skin barrier, wipes or swabs, each
|
HCPCS
|
HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next.
|
K0011
|
Stnd wt pwr whlchr w control
|
HCPCS
|
HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next.
|
Q4011
|
Cast sup sht arm ped plaster
|
HCPCS
|
HCPCS codes are five digits in length with no decimal holders and are alphanumeric in nature. Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next.
|
A5120
|
Skin barrier, wipes or swabs, each
|
HCPCS
|
Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index.
|
K0011
|
Stnd wt pwr whlchr w control
|
HCPCS
|
Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index.
|
Q4011
|
Cast sup sht arm ped plaster
|
HCPCS
|
Each codes begins with a letter and is followed by four numbers. The HCPCS book structured very similar to the CPT book. HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index.
|
A5120
|
Skin barrier, wipes or swabs, each
|
HCPCS
|
HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book.
|
K0011
|
Stnd wt pwr whlchr w control
|
HCPCS
|
HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book.
|
Q4011
|
Cast sup sht arm ped plaster
|
HCPCS
|
HCPCS Code ExamplesK0011 - Standard-weight frame motorized power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking
A5120 - Skin barrier, wipes or swabs, each
Q4011 - Cast supplies, short arm cast, pediatric (0-10 years), plaster. ~ The Table of Drugs with drugs listed alphabeticaly is next. ~ HCPCS modifiers listed with their full description is located between the Table of Drugs and the Tabula index. ~ The Tabular index lists all codes with their full description, conventions, and notations and is located in the center of the book. ~ Appendix A which is for Internet Only Manuals makes up the remainder of the book.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
The more than 7,000 five-character CPT Codes are an important part of the billing process. They are used by insurers to aid in determining the amount of reimbursement the physician or healthcare provider will receive for services rendered. CPT Codes are copyrighted and maintained by the American Medical Association (AMA). Updated annually, these codes fall into three major categories. - Category I- The codes range is 00100 to 99499.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
CPT Codes are copyrighted and maintained by the American Medical Association (AMA). Updated annually, these codes fall into three major categories. - Category I- The codes range is 00100 to 99499. Each five-digit code has a corresponding description of the procedure or service. - Category II – These are more of alphanumeric tracking codes to describe clinical components in clinic services or evaluation and management.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
CPT codes help government agencies keep tabs on the value and prevalence of particular procedures whereas hospitals may evaluate the efficiency of divisions and individuals in their facility using Current Procedural Terminology Codes. CPT Code Categories
Category I is concerning procedures and contemporary medical practices performed across the United States. This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
CPT codes help government agencies keep tabs on the value and prevalence of particular procedures whereas hospitals may evaluate the efficiency of divisions and individuals in their facility using Current Procedural Terminology Codes. CPT Code Categories
Category I is concerning procedures and contemporary medical practices performed across the United States. This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more.
|
01999
|
Unlisted anesth procedure
|
CPT
|
CPT codes help government agencies keep tabs on the value and prevalence of particular procedures whereas hospitals may evaluate the efficiency of divisions and individuals in their facility using Current Procedural Terminology Codes. CPT Code Categories
Category I is concerning procedures and contemporary medical practices performed across the United States. This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
CPT Code Categories
Category I is concerning procedures and contemporary medical practices performed across the United States. This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more. - Surgery (10000–69990) – which includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
CPT Code Categories
Category I is concerning procedures and contemporary medical practices performed across the United States. This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more. - Surgery (10000–69990) – which includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few.
|
10000
|
Incision & drainage of sebaceous cyst-one
|
CPT
|
CPT Code Categories
Category I is concerning procedures and contemporary medical practices performed across the United States. This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more. - Surgery (10000–69990) – which includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few.
|
01999
|
Unlisted anesth procedure
|
CPT
|
CPT Code Categories
Category I is concerning procedures and contemporary medical practices performed across the United States. This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more. - Surgery (10000–69990) – which includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more. - Surgery (10000–69990) – which includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few. - Radiology (70000-79999) –including ultrasound, mammography, bone/joint, oncology and nuclear medicine.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more. - Surgery (10000–69990) – which includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few. - Radiology (70000-79999) –including ultrasound, mammography, bone/joint, oncology and nuclear medicine.
|
10000
|
Incision & drainage of sebaceous cyst-one
|
CPT
|
This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more. - Surgery (10000–69990) – which includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few. - Radiology (70000-79999) –including ultrasound, mammography, bone/joint, oncology and nuclear medicine.
|
01999
|
Unlisted anesth procedure
|
CPT
|
This category is generally identified with the 5-character CPT Codes that identify a service or procedure sanctioned by the FDA, and performed by a physician or healthcare professional. This category is broken down into six sections and they are:
- Evaluation and Management (99201-99499) – which includes hospital observation services, office and other outpatient services, consultations, hospital inpatient services, emergency department, critical care services, nursing facility services, custodial care services and so on. - Anesthesiology (00100–01999; 99100–99150) – which includes procedures of the head, neck, thorax, infrathoracic, spine and spinal column, upper and lower abdomen, obstetrics and more. - Surgery (10000–69990) – which includes general surgery, integumentary system, musculoskeletal system, respiratory system, cardiovascular system, digestive system, urinary system, eye and reproductive, to name a few. - Radiology (70000-79999) –including ultrasound, mammography, bone/joint, oncology and nuclear medicine.
|
99199
|
Unlisted special svc px/rprt
|
CPT
|
- Radiology (70000-79999) –including ultrasound, mammography, bone/joint, oncology and nuclear medicine. - Pathology and Laboratory (80000–89398) – including organ or disease-oriented panels, drug testing, therapeutic drug assays, evocative/suppression testing, consultations (clinical pathology), urinalysis, transfusion medicine, microbiology and more. - Medicine (90281–99099; 99151–99199; 99500–99607) – including vaccines, toxoids, psychiatry, biofeedback, dialysis, gastroenterology, ophthalmology, special otorhinolaryngologic services, cardiovascular, noninvasive vascular diagnostic studies, pulmonary, allergy and clinical immunology, endocrinology and more. Category II pertains to clinical laboratory services. CPT codes for this category consist of secondary tracking codes employed for collecting information regarding quality of care rendered, and performance measurement.
|
99199
|
Unlisted special svc px/rprt
|
CPT
|
- Medicine (90281–99099; 99151–99199; 99500–99607) – including vaccines, toxoids, psychiatry, biofeedback, dialysis, gastroenterology, ophthalmology, special otorhinolaryngologic services, cardiovascular, noninvasive vascular diagnostic studies, pulmonary, allergy and clinical immunology, endocrinology and more. Category II pertains to clinical laboratory services. CPT codes for this category consist of secondary tracking codes employed for collecting information regarding quality of care rendered, and performance measurement. The use of these codes is not mandatory. Breakdown of Category II CPT Codes are:
- Composite Measures (0001F-0015F)
- Patient Management (0500F-0575F)
- Patient History (1000F-1220F)
- Physical Examination (2000F-2050F)
- Diagnostic/Screening Processes or Results (3006F-3573F)
- Therapeutic, Preventive or Other Interventions (4000F-4306F)
- Follow-up or Other Outcomes (5005F-5100F)
- Patient Safety (6005F-6045F)
- Structural Measures (7010F-7025F)
Category III is reserved for emerging technologies, with CPT codes of 0016T-0207T.
|
96115
|
Neurobehavior status exam
|
HCPCS
|
References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
|
96117
|
NEUROPSYCH TEST BATTERY
|
CPT
|
References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
|
96115
|
Neurobehavior status exam
|
HCPCS
|
References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing|
|
96117
|
NEUROPSYCH TEST BATTERY
|
CPT
|
References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing|
|
92508
|
Speech/hearing therapy
|
HCPCS
|
Inpatient benefits are considered not medically necessary if the hospital admission is solely for the purpose of receiving speech therapy. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY9/1994: Issued
11/1997: Prior authorization required; expanded description of non-covered services
2/14/2002: Investigational definition added
2/27/2002: Prior Authorization and Managed Care Requirements deleted
3/6/2002: Treatment plan submission to BCBSMS requirements before initiation of treatment deleted
5/7/2002: Type of Service and Place of Service deleted
6/23/2004: Policy reviewed, Sources updated
11/19/2004: Code Reference section updated, CPT 92506 added, CPT code 92598 typo should be 92508, ICD-9 procedure code range 93.72-93.75 listed separately, ICD-9 diagnosis code V57.3 added, HCPCS S9128 added
3/21/2006: Coding updated. CPT4 2006 revisions added to policy
4/11/2006: Policy reviewed, no changes
9/18/2006: Coding updated. ICD9 2006 revisions added to policy.
|
92598
|
Voice Prosthetic Modification
|
HCPCS
|
Inpatient benefits are considered not medically necessary if the hospital admission is solely for the purpose of receiving speech therapy. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY9/1994: Issued
11/1997: Prior authorization required; expanded description of non-covered services
2/14/2002: Investigational definition added
2/27/2002: Prior Authorization and Managed Care Requirements deleted
3/6/2002: Treatment plan submission to BCBSMS requirements before initiation of treatment deleted
5/7/2002: Type of Service and Place of Service deleted
6/23/2004: Policy reviewed, Sources updated
11/19/2004: Code Reference section updated, CPT 92506 added, CPT code 92598 typo should be 92508, ICD-9 procedure code range 93.72-93.75 listed separately, ICD-9 diagnosis code V57.3 added, HCPCS S9128 added
3/21/2006: Coding updated. CPT4 2006 revisions added to policy
4/11/2006: Policy reviewed, no changes
9/18/2006: Coding updated. ICD9 2006 revisions added to policy.
|
S9128
|
Speech therapy, in the home,
|
HCPCS
|
Inpatient benefits are considered not medically necessary if the hospital admission is solely for the purpose of receiving speech therapy. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY9/1994: Issued
11/1997: Prior authorization required; expanded description of non-covered services
2/14/2002: Investigational definition added
2/27/2002: Prior Authorization and Managed Care Requirements deleted
3/6/2002: Treatment plan submission to BCBSMS requirements before initiation of treatment deleted
5/7/2002: Type of Service and Place of Service deleted
6/23/2004: Policy reviewed, Sources updated
11/19/2004: Code Reference section updated, CPT 92506 added, CPT code 92598 typo should be 92508, ICD-9 procedure code range 93.72-93.75 listed separately, ICD-9 diagnosis code V57.3 added, HCPCS S9128 added
3/21/2006: Coding updated. CPT4 2006 revisions added to policy
4/11/2006: Policy reviewed, no changes
9/18/2006: Coding updated. ICD9 2006 revisions added to policy.
|
92506
|
ST SPEECH THERAPY EVALUATION
|
HCPCS
|
Inpatient benefits are considered not medically necessary if the hospital admission is solely for the purpose of receiving speech therapy. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY9/1994: Issued
11/1997: Prior authorization required; expanded description of non-covered services
2/14/2002: Investigational definition added
2/27/2002: Prior Authorization and Managed Care Requirements deleted
3/6/2002: Treatment plan submission to BCBSMS requirements before initiation of treatment deleted
5/7/2002: Type of Service and Place of Service deleted
6/23/2004: Policy reviewed, Sources updated
11/19/2004: Code Reference section updated, CPT 92506 added, CPT code 92598 typo should be 92508, ICD-9 procedure code range 93.72-93.75 listed separately, ICD-9 diagnosis code V57.3 added, HCPCS S9128 added
3/21/2006: Coding updated. CPT4 2006 revisions added to policy
4/11/2006: Policy reviewed, no changes
9/18/2006: Coding updated. ICD9 2006 revisions added to policy.
|
92508
|
Speech/hearing therapy
|
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 HISTORY9/1994: Issued
11/1997: Prior authorization required; expanded description of non-covered services
2/14/2002: Investigational definition added
2/27/2002: Prior Authorization and Managed Care Requirements deleted
3/6/2002: Treatment plan submission to BCBSMS requirements before initiation of treatment deleted
5/7/2002: Type of Service and Place of Service deleted
6/23/2004: Policy reviewed, Sources updated
11/19/2004: Code Reference section updated, CPT 92506 added, CPT code 92598 typo should be 92508, ICD-9 procedure code range 93.72-93.75 listed separately, ICD-9 diagnosis code V57.3 added, HCPCS S9128 added
3/21/2006: Coding updated. CPT4 2006 revisions added to policy
4/11/2006: Policy reviewed, no changes
9/18/2006: Coding updated. ICD9 2006 revisions added to policy. 6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
9/20/2007: Code Reference section updated.
|
92598
|
Voice Prosthetic Modification
|
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 HISTORY9/1994: Issued
11/1997: Prior authorization required; expanded description of non-covered services
2/14/2002: Investigational definition added
2/27/2002: Prior Authorization and Managed Care Requirements deleted
3/6/2002: Treatment plan submission to BCBSMS requirements before initiation of treatment deleted
5/7/2002: Type of Service and Place of Service deleted
6/23/2004: Policy reviewed, Sources updated
11/19/2004: Code Reference section updated, CPT 92506 added, CPT code 92598 typo should be 92508, ICD-9 procedure code range 93.72-93.75 listed separately, ICD-9 diagnosis code V57.3 added, HCPCS S9128 added
3/21/2006: Coding updated. CPT4 2006 revisions added to policy
4/11/2006: Policy reviewed, no changes
9/18/2006: Coding updated. ICD9 2006 revisions added to policy. 6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
9/20/2007: Code Reference section updated.
|
S9128
|
Speech therapy, in the home,
|
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 HISTORY9/1994: Issued
11/1997: Prior authorization required; expanded description of non-covered services
2/14/2002: Investigational definition added
2/27/2002: Prior Authorization and Managed Care Requirements deleted
3/6/2002: Treatment plan submission to BCBSMS requirements before initiation of treatment deleted
5/7/2002: Type of Service and Place of Service deleted
6/23/2004: Policy reviewed, Sources updated
11/19/2004: Code Reference section updated, CPT 92506 added, CPT code 92598 typo should be 92508, ICD-9 procedure code range 93.72-93.75 listed separately, ICD-9 diagnosis code V57.3 added, HCPCS S9128 added
3/21/2006: Coding updated. CPT4 2006 revisions added to policy
4/11/2006: Policy reviewed, no changes
9/18/2006: Coding updated. ICD9 2006 revisions added to policy. 6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
9/20/2007: Code Reference section updated.
|
92506
|
ST SPEECH THERAPY EVALUATION
|
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 HISTORY9/1994: Issued
11/1997: Prior authorization required; expanded description of non-covered services
2/14/2002: Investigational definition added
2/27/2002: Prior Authorization and Managed Care Requirements deleted
3/6/2002: Treatment plan submission to BCBSMS requirements before initiation of treatment deleted
5/7/2002: Type of Service and Place of Service deleted
6/23/2004: Policy reviewed, Sources updated
11/19/2004: Code Reference section updated, CPT 92506 added, CPT code 92598 typo should be 92508, ICD-9 procedure code range 93.72-93.75 listed separately, ICD-9 diagnosis code V57.3 added, HCPCS S9128 added
3/21/2006: Coding updated. CPT4 2006 revisions added to policy
4/11/2006: Policy reviewed, no changes
9/18/2006: Coding updated. ICD9 2006 revisions added to policy. 6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
9/20/2007: Code Reference section updated.
|
1743
|
Percutaneous robotic assisted procedure
|
ICD
|
2010, 7, 1720–1743. [Google Scholar] [CrossRef]
- Good Health Adds Life to Years. Global Brief for World Health Day 2012; WHO: Geneva, Switzerland, 2012. - Giannangelo, K.; Millar, J. Mapping SNOMED CT to ICD-10. Stud.
|
99396
|
PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS
|
HCPCS
|
Healthcare service providers utilize these codes all across the United States. The code has five digits that denote a particular type of test or procedure depending on the code combination. These codes are also referred to as HCPCS Level I codes or service codes. An individual can make a quick CPT search to verify if the service offered to them corresponds to what is on the bill. An example of a CPT code is 99396, which denotes the code for a preventive visit to a healthcare facility.
|
99396
|
PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS
|
HCPCS
|
The code has five digits that denote a particular type of test or procedure depending on the code combination. These codes are also referred to as HCPCS Level I codes or service codes. An individual can make a quick CPT search to verify if the service offered to them corresponds to what is on the bill. An example of a CPT code is 99396, which denotes the code for a preventive visit to a healthcare facility. The type of diagnostic service given to an individual is denoted by ICD-10 or ICD-9 code.
|
99396
|
PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS
|
HCPCS
|
These codes are also referred to as HCPCS Level I codes or service codes. An individual can make a quick CPT search to verify if the service offered to them corresponds to what is on the bill. An example of a CPT code is 99396, which denotes the code for a preventive visit to a healthcare facility. The type of diagnostic service given to an individual is denoted by ICD-10 or ICD-9 code. In America, the ICD-10 is mainly used.
|
20694
|
Rmvl ext fixj sys under anes
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
21206
|
Reconstruct upper jaw bone
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
42200
|
Reconstruct cleft palate
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
D6199
|
PR UNSPEC IMPLANT PROCEDURE BY REPORT
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
21196
|
Reconst lwr jaw w/fixation
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
21247
|
Reconstruct lower jaw bone
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
D8999
|
PR UNS ORTHODONTIC PROCEDURE BY REPORT
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
20693
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
D8010
|
PR LTD ORTHODONT TX PRIMARY DENTITION
|
HCPCS
|
The mean follow-up time was 28.7 months. The authors concluded that in addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|20692||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)|
|20693||Adjustment or revision of external fixation system requiring anesthesia (eg, new pin(s) or wire(s) and/or new ring(s) or bar(s))|
|20694||Removal, under anesthesia, of external fixation system|
|20696||Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)|
|20697||exchange (ie, removal and replacement) of strut, each|
|CPT codes not covered for indications listed in the CPB:|
|0232T||Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed|
|Other CPT codes related to the CPB:|
|21110||Application of interdental fixation device for conditions other than fracture or dislocation, includes removal|
|21120 - 21196||Repair, revision, and/or reconstruction bones of face|
|21206||Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)|
|21210||Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)|
|21247||Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)|
|30400 - 30462||Rhinoplasty|
|38220||Bone marrow, aspiration only|
|42200 - 42225||Palatoplasty|
|HCPCS codes not covered for indicationslisted in the CPB:|
|S9055||Procuren or other growth factor preparation to promote wound healing|
|Other HCPCS codes related to the CPB:|
|D6010 - D6199||Implant services|
|D7946 - D7949||LeFort procedures I, II, or III|
|D8010 - D8999||Orthodontic dental procedures|
|ICD-10 codes covered if selection criteria are met:|
|M26.00 - M26.59||Dentofacial anomalies [including malocclusion]|
|Q35.1 - Q35.9||Cleft palate|
|Q37.0 - Q37.9||Cleft palate with cleft lip|
|Q67.0 - Q67.4||Congenital deformities of skull, face and jaw|
|Q75.0 - Q75.9||Congenital malformation of skull and face bones [includes hemifacial microstomia]|
|Q87.0||Congenital malformation syndromes predominantly affecting facial appearance|
|ICD-10 codes not covered for indications listed in the CPB:|
|G47.33||Obstructive sleep apnea (adult) (pediatric)|
|M95.2||Other acquired deformity of head [acquired craniofacial defects]|
|Z41.1||Encounter for cosmetic surgery|
|Z46.3||Encounter for fitting and adjustment of dental prosthetic device|
|Z46.4||Encounter for fitting and adjustment of orthodontic device|
|
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