code stringlengths 4 12 | description stringlengths 2 264 | codetype stringclasses 8
values | context stringlengths 160 15.5k |
|---|---|---|---|
G0360 | Each additional hr 1-8 hrs | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38213 | PR TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38215 | PR TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0361 | Prolong chemo infuse>8hrs pu | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38211 | Tumor cell deplete of harvst | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38207 | PR TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38208 | Thaw preserved stem cells | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0359 | Chemotherapy IV one hr initi | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38210 | T-cell depletion of harvest | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38212 | Rbc depletion of harvest | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
38205 | PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0362 | Each add sequential infusion | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0357 | IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0356 | HORMONAL ANTINEOPLASTIC | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | POLICY HISTORY3/25/2004: See policy "Allogeneic Stem Cell Transplant" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.22
8/19/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/27/2005: Code Reference section updated; CPT-4 codes 38204, 38205, 38207, 38... |
G0267 | Bone marrow or psc harvest | CPT | ICD9 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc... |
G0266 | Thawing + expansion froz cel | CPT | ICD9 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc... |
G0265 | Cryopresevation Freeze+stora | CPT | ICD9 2006 revisions added to policy
12/21/2006: Policy reviewed, no changes
9/18/2007: Code reference section updated. ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 proc... |
G0267 | Bone marrow or psc harvest | CPT | ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ... |
G0266 | Thawing + expansion froz cel | CPT | ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ... |
G0265 | Cryopresevation Freeze+stora | CPT | ICD-9 2007 revisions added to policy
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 285.3 added to covered table. ICD-9 procedure code 284.8 deleted from covered table due to code was deleted as of 9-30-2007. HCPC codes G0265, G0266 and G0267 ... |
81003 | URINE SPECIFIC GRAVITY | 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... |
81005 | URINALYSIS | 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... |
81001 | URINALYSIS AUTO W/SCOPE | 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... |
81099 | URINE COLLECTION | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
1999 | ANESTHESIOLOGY GROUP | CPT | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus... |
81015 | URINE MICROSCOPIC (ONLY) | 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... |
81000 | HC URINALYSIS, BY DIP STICK OR TABLET REAGENT; NON-AUTOMATED, WI | 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... |
81002 | URN DIPST/TAB RGNT NONAUTO W/O | 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... |
81020 | Urinalysis glass test | 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... |
81007 | Urine screen for bacteria | 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... |
86316 | IMMUNOASSAY FOR TUMOR ANTIGEN, OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4, 549), EACH | 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... |
81003 | URINE SPECIFIC GRAVITY | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
81005 | URINALYSIS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
81001 | URINALYSIS AUTO W/SCOPE | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
81099 | URINE COLLECTION | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
1999 | ANESTHESIOLOGY GROUP | CPT | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
81015 | URINE MICROSCOPIC (ONLY) | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
81000 | HC URINALYSIS, BY DIP STICK OR TABLET REAGENT; NON-AUTOMATED, WI | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
88368 | PR M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
88367 | PR M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
88271 | MOLECULAR CYTOGENETICS_ DNA PROBE, EACH (EG, FISH) | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
88299 | Unlisted cytogenetic study | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
81002 | URN DIPST/TAB RGNT NONAUTO W/O | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
81020 | Urinalysis glass test | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
81007 | Urine screen for bacteria | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
86316 | IMMUNOASSAY FOR TUMOR ANTIGEN, OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4, 549), EACH | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 8/1999: Approved by Medical Policy Advisory Committee (MPAC)
6/28/2001: Coding Reference section updated, tables added, CPT codes 81000, 81001, 81002, 81003, 81005, 81007, 81015, 8102... |
88368 | PR M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL | HCPCS | HCPCS 2006 revisions added to policy
12/04/2006: Description and policy section updated. Code Reference section updated. Added CPT code 83365, and ICD-9 code 599.7
4/29/2008: Policy reviewed, no changes
9/19/2008: Annual ICD-9 updates effective 10-1-2008 applied
7/24/2009: Policy Description section updated for clarifi... |
88367 | PR M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN | HCPCS | HCPCS 2006 revisions added to policy
12/04/2006: Description and policy section updated. Code Reference section updated. Added CPT code 83365, and ICD-9 code 599.7
4/29/2008: Policy reviewed, no changes
9/19/2008: Annual ICD-9 updates effective 10-1-2008 applied
7/24/2009: Policy Description section updated for clarifi... |
88299 | Unlisted cytogenetic study | HCPCS | HCPCS 2006 revisions added to policy
12/04/2006: Description and policy section updated. Code Reference section updated. Added CPT code 83365, and ICD-9 code 599.7
4/29/2008: Policy reviewed, no changes
9/19/2008: Annual ICD-9 updates effective 10-1-2008 applied
7/24/2009: Policy Description section updated for clarifi... |
88271 | MOLECULAR CYTOGENETICS_ DNA PROBE, EACH (EG, FISH) | HCPCS | HCPCS 2006 revisions added to policy
12/04/2006: Description and policy section updated. Code Reference section updated. Added CPT code 83365, and ICD-9 code 599.7
4/29/2008: Policy reviewed, no changes
9/19/2008: Annual ICD-9 updates effective 10-1-2008 applied
7/24/2009: Policy Description section updated for clarifi... |
86316 | IMMUNOASSAY FOR TUMOR ANTIGEN, OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4, 549), EACH | HCPCS | HCPCS 2006 revisions added to policy
12/04/2006: Description and policy section updated. Code Reference section updated. Added CPT code 83365, and ICD-9 code 599.7
4/29/2008: Policy reviewed, no changes
9/19/2008: Annual ICD-9 updates effective 10-1-2008 applied
7/24/2009: Policy Description section updated for clarifi... |
A4650 | Implant radiation dosimeter | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
61797 | Srs cran les simple addl | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
G0251 | Linear acc based stero radio | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
77372 | Srs linear based | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
77432 | Stereotactic radiation trmt | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
G0339 | Robot lin-radsurg com, first | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
63621 | Srs spinal lesion addl | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
77371 | HC RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
77373 | Sbrt delivery | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
G0340 | Robt lin-radsurg fractx 2-5 | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
G0173 | STEREO RADOISURGERY,COMPLETE | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
63620 | Srs spinal lesion | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
77435 | HC STEREOTACTIC BODY RADIATION MANAGEMENT | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
A4648 | WIRE LOCAL SPECBOARD | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
61798 | Srs cranial lesion complex | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
61800 | PR APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
61799 | Srs cran les complex addl | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
20660 | PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
61796 | Srs cranial lesion simple | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
32701 | Thorax stereo rad targetw/tx | HCPCS | For treatment to additional lesions, further clinical justification may be needed. Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All ot... |
A4650 | Implant radiation dosimeter | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
61797 | Srs cran les simple addl | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
G0251 | Linear acc based stero radio | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
77372 | Srs linear based | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
77432 | Stereotactic radiation trmt | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
G0339 | Robot lin-radsurg com, first | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
63621 | Srs spinal lesion addl | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
77371 | HC RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
77373 | Sbrt delivery | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
G0340 | Robt lin-radsurg fractx 2-5 | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
G0173 | STEREO RADOISURGERY,COMPLETE | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
63620 | Srs spinal lesion | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
77435 | HC STEREOTACTIC BODY RADIATION MANAGEMENT | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
A4648 | WIRE LOCAL SPECBOARD | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
61798 | Srs cranial lesion complex | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
61800 | PR APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
61799 | Srs cran les complex addl | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
20660 | PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
61796 | Srs cranial lesion simple | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
32701 | Thorax stereo rad targetw/tx | HCPCS | Stereotactic body radiation therapy is considered medically necessary for localized malignant conditions within the body where highly precise application of high-dose radiotherapy is required and clinically appropriate, including:
All other clinical sites or indications are considered experimental and investigational b... |
A9500 | TECHNETIUM TC 99M SESTAMIBI IV KIT | HCPCS | Scintimammography, breast-specific gamma imaging (BSGI), and molecular breast imaging (MBI) are considered investigational in all applications, including but not limited to their use as an adjunct to mammography or in staging the axillary lymph nodes. Preoperative or intraoperative sentinel lymph node detection using h... |
A9500 | TECHNETIUM TC 99M SESTAMIBI IV KIT | HCPCS | Preoperative or intraoperative sentinel lymph node detection using handheld or mounted mobile gamma cameras is considered investigational. The most commonly used radiopharmaceutical used in for BSGI or MBI is technetium Tc 99m sestamibi (marketed by Draxis Specialty Pharmaceuticals Inc., Cardinal Health 414, LLC, Malli... |
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