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30462 | Revision of nose | 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 appropriat... |
21110 | PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC | 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 appropriat... |
0232T | Njx platelet plasma | 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 appropriat... |
21210 | PR GRAFT BONE NASAL/MAXILLARY/MALAR AREAS | 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 appropriat... |
20696 | PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT 1ST&SUBSQ | 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 appropriat... |
30400 | Reconstruction of nose | 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 appropriat... |
21120 | Reconstruction of chin | 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 appropriat... |
20692 | PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM | 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 appropriat... |
38220 | PR DIAGNOSTIC BONE MARROW ASPIRATIONS | 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 appropriat... |
D7949 | Reconstruct midface w/graft | 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 appropriat... |
42225 | 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 appropriat... |
20697 | PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE | 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 appropriat... |
D6010 | PR SURG PLCMT IMPL BODY: ENDOSTEAL | 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 appropriat... |
S9055 | Procuren or other growth fac | 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 appropriat... |
D7946 | Reconstruction maxilla total | 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 appropriat... |
20694 | Rmvl ext fixj sys under anes | HCPCS | 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... |
21206 | Reconstruct upper jaw bone | HCPCS | 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... |
42200 | Reconstruct cleft palate | HCPCS | 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... |
D6199 | PR UNSPEC IMPLANT PROCEDURE BY REPORT | HCPCS | 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... |
21196 | Reconst lwr jaw w/fixation | HCPCS | 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... |
21247 | Reconstruct lower jaw bone | HCPCS | 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... |
D8999 | PR UNS ORTHODONTIC PROCEDURE BY REPORT | HCPCS | 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... |
20693 | PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES | HCPCS | 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... |
D8010 | PR LTD ORTHODONT TX PRIMARY DENTITION | HCPCS | 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... |
30462 | Revision of nose | HCPCS | 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... |
21110 | PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC | HCPCS | 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... |
0232T | Njx platelet plasma | HCPCS | 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... |
21210 | PR GRAFT BONE NASAL/MAXILLARY/MALAR AREAS | HCPCS | 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... |
20696 | PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT 1ST&SUBSQ | HCPCS | 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... |
30400 | Reconstruction of nose | HCPCS | 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... |
21120 | Reconstruction of chin | HCPCS | 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... |
20692 | PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM | HCPCS | 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... |
38220 | PR DIAGNOSTIC BONE MARROW ASPIRATIONS | HCPCS | 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... |
D7949 | Reconstruct midface w/graft | HCPCS | 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... |
42225 | Reconstruct cleft palate | HCPCS | 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... |
20697 | PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE | HCPCS | 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... |
D6010 | PR SURG PLCMT IMPL BODY: ENDOSTEAL | HCPCS | 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... |
S9055 | Procuren or other growth fac | HCPCS | 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... |
D7946 | Reconstruction maxilla total | HCPCS | 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... |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | HCPCS Level III contains alphanumeric codes that are assigned
by Medicaid state agencies to identify additional items
and services not included in levels I or II. These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three ... |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three levels, with the WA - ZY range used for locally
assigned procedure modifiers. - Health Insurance Portability &
Accountability Act (HIPAA) – A law passed
in 1996 wh... |
A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries | HCPCS | 04/12/2010: Description section revised to add the four oncologic applications of PET Scanning; Policy section revised to add indications considered medically necessary for Melanoma, Lymphoma, lung; colorectal; pancreatic; head & neck; esophageal; breast; ovarian and testicular cancers. Added indications considered med... |
A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries | HCPCS | Added indications considered medically necessary for differentiated thyroid and cervical cancers; added prostate cancer and cancer surveillance as investigational for all indications. Code reference section revised to add the following ICD-9 diagnosis codes to the covered codes table: 140.0 - 140.9; 141.0 - 141.9; 142.... |
A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries | HCPCS | Code reference section revised to add the following ICD-9 diagnosis codes to the covered codes table: 140.0 - 140.9; 141.0 - 141.9; 142.0 - 142.9; 143.0 - 143.9; 150.0 -150.9; 151.0 - 151.9, 155.1; 156.0; 156.2; 157.0 -157.9; 158.0 - 158.9; 159.0 - 159.9; 174.0 - 174.5 and 174.8 - 174.9; 175.0; 175.9; 180.0 - 180.9; 18... |
A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries | HCPCS | Moved HCPCS Code A9580 from non-covered to covered table. 10/05/2010: Policy reviewed; policy statement unchanged. Removed the following ICD-9 codes from the Covered Codes table to be consistent with the policy statement: 151.0-151.9, 152.0-152.9, 155.0-155.2, 156.0-156.9, 158.0-158.9, 159.0, 159.1, 159.8, 159.9, 194.0... |
97533 | Therapy procedure using sensory experiences | HCPCS | Studies of sensory-based interventions suggested that they may not be effective; however, they did not follow recommended protocols or target sensory processing problems. The authors concluded that although small RCTs resulted in positive effects for SIT, additional rigorous trials using manualized protocols for SIT ar... |
97533 | Therapy procedure using sensory experiences | HCPCS | The authors concluded that although small RCTs resulted in positive effects for SIT, additional rigorous trials using manualized protocols for SIT are needed to evaluate effects for children with ASDs and sensory processing problems. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been... |
G0202 | Scr mammo bi incl cad | HCPCS | Digital screening mammogram with CAD was performed. Findings: Negative. CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.11
Example 2:Patient is a 52-year old female with a personal history of breast cancer, fully resolved status post right breast mastectomy in 1992. She presents for annual digital screening mammogram... |
77052 | Comp screen mammogram add-on | HCPCS | Digital screening mammogram with CAD was performed. Findings: Negative. CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.11
Example 2:Patient is a 52-year old female with a personal history of breast cancer, fully resolved status post right breast mastectomy in 1992. She presents for annual digital screening mammogram... |
G0202 | Scr mammo bi incl cad | HCPCS | CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.11
Example 2:Patient is a 52-year old female with a personal history of breast cancer, fully resolved status post right breast mastectomy in 1992. She presents for annual digital screening mammogram with CAD. CPT/HCPCS Codes: G0202-52, 77052
ICD-9-CM Codes: V76.11, V10.... |
77052 | Comp screen mammogram add-on | HCPCS | CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.11
Example 2:Patient is a 52-year old female with a personal history of breast cancer, fully resolved status post right breast mastectomy in 1992. She presents for annual digital screening mammogram with CAD. CPT/HCPCS Codes: G0202-52, 77052
ICD-9-CM Codes: V76.11, V10.... |
G0202 | Scr mammo bi incl cad | HCPCS | Bilateral subglandular breast implants are noted. Implants appear stable and mammographically intact. CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.12
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing pleas... |
77052 | Comp screen mammogram add-on | HCPCS | Bilateral subglandular breast implants are noted. Implants appear stable and mammographically intact. CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.12
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing pleas... |
G0202 | Scr mammo bi incl cad | HCPCS | Implants appear stable and mammographically intact. CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.12
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-... |
77052 | Comp screen mammogram add-on | HCPCS | Implants appear stable and mammographically intact. CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.12
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-... |
L8692 | Non-osseointegrated snd proc | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and ... |
L8692 | Non-osseointegrated snd proc | HCPCS | The coverage guidelines outlined in the Medical Policy should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/24/2007: Policy added
9/19/2007: Code reference section updated. ICD-9 2007 revisions added to policy
11/15/2007: Policy approved by MPAC
10/7/2008: Policy reviewed, no chang... |
L8692 | Non-osseointegrated snd proc | HCPCS | POLICY HISTORY8/24/2007: Policy added
9/19/2007: Code reference section updated. ICD-9 2007 revisions added to policy
11/15/2007: Policy approved by MPAC
10/7/2008: Policy reviewed, no changes
3/15/2010: Code Reference section updated. New HCPCS code L8692 added to covered table. 04/21/2010: Policy description updated ... |
L8692 | Non-osseointegrated snd proc | HCPCS | ICD-9 2007 revisions added to policy
11/15/2007: Policy approved by MPAC
10/7/2008: Policy reviewed, no changes
3/15/2010: Code Reference section updated. New HCPCS code L8692 added to covered table. 04/21/2010: Policy description updated regarding FDA approval of devices. The medically necessary policy statements were... |
L8692 | Non-osseointegrated snd proc | HCPCS | New HCPCS code L8692 added to covered table. 04/21/2010: Policy description updated regarding FDA approval of devices. The medically necessary policy statements were revised to add “5 years of age and older” to be consistent with FDA-approved labeling. “Sensorineural” added to the second statement. The intent of the po... |
L8693 | IMPL COCLR 4MM BAHA TI ABTMNT B1300 | HCPCS | The intent of the policy statements unchanged. FEP verbiage added to the Policy Exceptions section. 03/09/2011: Added new HCPCS code L8693 to the Code Reference section. 04/25/2011: Audiologic criteria moved from the policy guidelines to the policy statement. 03/02/2012: Added policy statement to indicate that partiall... |
L8693 | IMPL COCLR 4MM BAHA TI ABTMNT B1300 | HCPCS | FEP verbiage added to the Policy Exceptions section. 03/09/2011: Added new HCPCS code L8693 to the Code Reference section. 04/25/2011: Audiologic criteria moved from the policy guidelines to the policy statement. 03/02/2012: Added policy statement to indicate that partially implantable bone conduction hearing systems u... |
L8693 | IMPL COCLR 4MM BAHA TI ABTMNT B1300 | HCPCS | 03/09/2011: Added new HCPCS code L8693 to the Code Reference section. 04/25/2011: Audiologic criteria moved from the policy guidelines to the policy statement. 03/02/2012: Added policy statement to indicate that partially implantable bone conduction hearing systems using magnetic coupling for acoustic transmission are ... |
G0358 | IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
86816 | HC HLA TYPING DR/DQ SINGLE AG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0360 | Each additional hr 1-8 hrs | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
96520 | Port pump refill & main | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
S2150 | Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; m | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
86821 | Lymphocyte culture mixed | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
Q0083 | Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
38215 | PR TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0361 | Prolong chemo infuse>8hrs pu | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
86822 | Lymphocyte culture primed | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
38240 | Transplt allo hct/donor | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
96545 | Cancer chemotherapy | CPT | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0359 | Chemotherapy IV one hr initi | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
Q0085 | Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
86817 | HC HLA TYPING; DR/DQ, MULTIPLE ANTIGENS | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
96530 | Syst pump refill & main | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
38205 | PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0362 | Each add sequential infusion | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
Q0084 | HC CHEMOTHERAPY - IM PHYS | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
38242 | Transplt allo lymphocytes | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0357 | IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0356 | HORMONAL ANTINEOPLASTIC | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
G0358 | IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 1/2004: Interim policy, High-dose chemotherapy with autologous stem-cell support considered investigational to treat primary amyloidosis or Waldenstrom's macroglobulinemia
3/25/2004: ... |
86816 | HC HLA TYPING DR/DQ SINGLE AG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 1/2004: Interim policy, High-dose chemotherapy with autologous stem-cell support considered investigational to treat primary amyloidosis or Waldenstrom's macroglobulinemia
3/25/2004: ... |
G0360 | Each additional hr 1-8 hrs | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 1/2004: Interim policy, High-dose chemotherapy with autologous stem-cell support considered investigational to treat primary amyloidosis or Waldenstrom's macroglobulinemia
3/25/2004: ... |
96520 | Port pump refill & main | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 1/2004: Interim policy, High-dose chemotherapy with autologous stem-cell support considered investigational to treat primary amyloidosis or Waldenstrom's macroglobulinemia
3/25/2004: ... |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 1/2004: Interim policy, High-dose chemotherapy with autologous stem-cell support considered investigational to treat primary amyloidosis or Waldenstrom's macroglobulinemia
3/25/2004: ... |
S2150 | Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; m | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 1/2004: Interim policy, High-dose chemotherapy with autologous stem-cell support considered investigational to treat primary amyloidosis or Waldenstrom's macroglobulinemia
3/25/2004: ... |
86821 | Lymphocyte culture mixed | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 1/2004: Interim policy, High-dose chemotherapy with autologous stem-cell support considered investigational to treat primary amyloidosis or Waldenstrom's macroglobulinemia
3/25/2004: ... |
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