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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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
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 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|
|
77385
|
HC IMRT SIMPLE
|
HCPCS
|
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
|
77418
|
Radiation tx delivery imrt
|
HCPCS
|
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
|
77387
|
HC STEREOSCOPIC X-RAY GUIDANCE
|
HCPCS
|
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
|
G6015
|
Radiation tx delivery imrt
|
HCPCS
|
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
|
0073T
|
Delivery comp imrt
|
HCPCS
|
New CPT codes 77385-77387, effective 1/1/15, added to policy; deleted code 0073T and 77418 noted on policy effective 12/31/14. Coding update. New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15.
|
G6015
|
Radiation tx delivery imrt
|
HCPCS
|
New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15. Annual Review. Policy updated with literature review through March 5, 2015.
|
77387
|
HC STEREOSCOPIC X-RAY GUIDANCE
|
HCPCS
|
New code 77387 removed from policy; this is not specific to IMRT. Coding update. HCPCS code G6015 added to the policy, new code effective 1/1/15. Annual Review. Policy updated with literature review through March 5, 2015.
|
G6015
|
Radiation tx delivery imrt
|
HCPCS
|
HCPCS code G6015 added to the policy, new code effective 1/1/15. Annual Review. Policy updated with literature review through March 5, 2015. Reference 12 added, and reference 13 updated. Title changed from “radiation therapy” to “radiotherapy” to be consistent with other medical policies.
|
1996
|
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
|
HCPCS
|
CMS is considering phasing out HCPCS. There are 3 levels within HCPCS:
HCPCS Level 1
Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index). HCPCS Level 2
Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCPCS Level 3
Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding.
|
1996
|
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
|
HCPCS
|
There are 3 levels within HCPCS:
HCPCS Level 1
Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index). HCPCS Level 2
Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCPCS Level 3
Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003.
|
1996
|
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
|
HCPCS
|
HCPCS Level 2
Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCPCS Level 3
Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003. Current Procedural Terminology (CPT) is an outpatient medical coding codeset that is copy-written by the American Medical Association.
|
1996
|
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
|
HCPCS
|
HCPCS Level 3
Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003. Current Procedural Terminology (CPT) is an outpatient medical coding codeset that is copy-written by the American Medical Association. Despite CPT's widespread use, you have to pay high licensing fees to use the CPT codeset.
|
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 as such therefore is not considered medially necessary. 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 changes
3/15/2010: Code Reference section updated. New HCPCS code L8692 added to covered table.
|
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 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.
|
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 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.
|
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 revised to add “5 years of age and older” to be consistent with FDA-approved labeling. “Sensorineural” added to the second statement.
|
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 policy statements unchanged.
|
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 partially implantable bone conduction hearing systems using magnetic coupling for acoustic transmission are considered investigational.
|
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 using magnetic coupling for acoustic transmission are considered investigational. Other policy statements unchanged.
|
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 considered investigational. Other policy statements unchanged. 04/04/2013: Policy reviewed; no changes.
|
95904
|
Sense nerve conduction 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 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/2/2007: Policy added
3/22/2007: Reviewed and approved by Medical Policy Advisory Committee (MPAC)
6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
10/11/2007: Code Reference section reviewed. CPT 95900, 95903, and 95904 removed from policy as non-covered for an automated point of care nerve conduction test (Note: Standard nerve conduction tests may be covered with these Copts); a specific HCPCS code for an automated point of care nerve conduction test became effective 7-1-2007
7/6/2009: Policy reviewed, description updated, policy statement unchanged
11/03/2010: Policy description section revised to provide a list of devices and research findings regarding portable automated nerve conduction tests compared to standard testing. Policy statement unchanged.
|
95903
|
Motor nerve conduction 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 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/2/2007: Policy added
3/22/2007: Reviewed and approved by Medical Policy Advisory Committee (MPAC)
6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
10/11/2007: Code Reference section reviewed. CPT 95900, 95903, and 95904 removed from policy as non-covered for an automated point of care nerve conduction test (Note: Standard nerve conduction tests may be covered with these Copts); a specific HCPCS code for an automated point of care nerve conduction test became effective 7-1-2007
7/6/2009: Policy reviewed, description updated, policy statement unchanged
11/03/2010: Policy description section revised to provide a list of devices and research findings regarding portable automated nerve conduction tests compared to standard testing. Policy statement unchanged.
|
95900
|
Motor nerve conduction 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 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/2/2007: Policy added
3/22/2007: Reviewed and approved by Medical Policy Advisory Committee (MPAC)
6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
10/11/2007: Code Reference section reviewed. CPT 95900, 95903, and 95904 removed from policy as non-covered for an automated point of care nerve conduction test (Note: Standard nerve conduction tests may be covered with these Copts); a specific HCPCS code for an automated point of care nerve conduction test became effective 7-1-2007
7/6/2009: Policy reviewed, description updated, policy statement unchanged
11/03/2010: Policy description section revised to provide a list of devices and research findings regarding portable automated nerve conduction tests compared to standard testing. Policy statement unchanged.
|
95904
|
Sense nerve conduction 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. POLICY HISTORY3/2/2007: Policy added
3/22/2007: Reviewed and approved by Medical Policy Advisory Committee (MPAC)
6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
10/11/2007: Code Reference section reviewed. CPT 95900, 95903, and 95904 removed from policy as non-covered for an automated point of care nerve conduction test (Note: Standard nerve conduction tests may be covered with these Copts); a specific HCPCS code for an automated point of care nerve conduction test became effective 7-1-2007
7/6/2009: Policy reviewed, description updated, policy statement unchanged
11/03/2010: Policy description section revised to provide a list of devices and research findings regarding portable automated nerve conduction tests compared to standard testing. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.
|
95903
|
Motor nerve conduction 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. POLICY HISTORY3/2/2007: Policy added
3/22/2007: Reviewed and approved by Medical Policy Advisory Committee (MPAC)
6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
10/11/2007: Code Reference section reviewed. CPT 95900, 95903, and 95904 removed from policy as non-covered for an automated point of care nerve conduction test (Note: Standard nerve conduction tests may be covered with these Copts); a specific HCPCS code for an automated point of care nerve conduction test became effective 7-1-2007
7/6/2009: Policy reviewed, description updated, policy statement unchanged
11/03/2010: Policy description section revised to provide a list of devices and research findings regarding portable automated nerve conduction tests compared to standard testing. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.
|
95900
|
Motor nerve conduction 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. POLICY HISTORY3/2/2007: Policy added
3/22/2007: Reviewed and approved by Medical Policy Advisory Committee (MPAC)
6/14/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
10/11/2007: Code Reference section reviewed. CPT 95900, 95903, and 95904 removed from policy as non-covered for an automated point of care nerve conduction test (Note: Standard nerve conduction tests may be covered with these Copts); a specific HCPCS code for an automated point of care nerve conduction test became effective 7-1-2007
7/6/2009: Policy reviewed, description updated, policy statement unchanged
11/03/2010: Policy description section revised to provide a list of devices and research findings regarding portable automated nerve conduction tests compared to standard testing. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
The American Medical Association was first to introduce Current Procedural Terminology codes. It was in the 1960s and its aim was to enable medical staff to use standardized terms to document procedures and services in medical records. Nowadays, more than 10,000 different 6-digit CPT codes ranging between 00100 and 99499 exist and each code consists of six digits. Furthermore, two-digit modifying codes can be added with the aim to provide more clarification on the specifics of a procedure that has to be done. These additional digits in codes are required in cases when the code only describes a part of a procedure.
|
1000
|
HC ASAM LEVEL 3.7 MEDICALLY MONITORED INPATIENT
|
RC
|
The ICD-10 codes are applicable for hospital inpatient procedures. ICD-10-PCS (Procedure Coding System), designed by 3M Health Information Management for Centers of Medicare and Medicaid, is the code set to replace the Volume 3 of ICD-9-CM for inpatient procedure reporting. This ICD-10-PCS has approx. 71000 alpha-numeric codes which has seven digits. Structure of ICD-10-PCS Codes:
In the structure,
For the example shown above, ICD-10 code for knee joint replacement (0SRC0JZ – Replacement of Right Knee Joint with Synthetic Substitute, Open Approach) means the following:
For more information on ICD-10-PCD codes, click here: https://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/08_ICD10.asp
Moving to ICD-10 will speed up the medical reimbursement process in the industry and reduce the payment errors.
|
1000
|
HC ASAM LEVEL 3.7 MEDICALLY MONITORED INPATIENT
|
RC
|
ICD-10-PCS (Procedure Coding System), designed by 3M Health Information Management for Centers of Medicare and Medicaid, is the code set to replace the Volume 3 of ICD-9-CM for inpatient procedure reporting. This ICD-10-PCS has approx. 71000 alpha-numeric codes which has seven digits. Structure of ICD-10-PCS Codes:
In the structure,
For the example shown above, ICD-10 code for knee joint replacement (0SRC0JZ – Replacement of Right Knee Joint with Synthetic Substitute, Open Approach) means the following:
For more information on ICD-10-PCD codes, click here: https://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/08_ICD10.asp
Moving to ICD-10 will speed up the medical reimbursement process in the industry and reduce the payment errors. It also enhances the quality of healthcare offered to patients.
|
1000
|
HC ASAM LEVEL 3.7 MEDICALLY MONITORED INPATIENT
|
RC
|
This ICD-10-PCS has approx. 71000 alpha-numeric codes which has seven digits. Structure of ICD-10-PCS Codes:
In the structure,
For the example shown above, ICD-10 code for knee joint replacement (0SRC0JZ – Replacement of Right Knee Joint with Synthetic Substitute, Open Approach) means the following:
For more information on ICD-10-PCD codes, click here: https://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/08_ICD10.asp
Moving to ICD-10 will speed up the medical reimbursement process in the industry and reduce the payment errors. It also enhances the quality of healthcare offered to patients. The Department of Health & Human Services (HHS) published the final rules for adoption of new HIPAA standards on January 16, 2009.
|
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.
|
28309
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
L1960
|
HC SUPPLY ANKLE FOOT ORTHOSIS POSTERIOR SOLID ANKLE CUSTOM - L1960
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
28285
|
Repair of hammertoe
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
L2300
|
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
L2280
|
Molded inner boot
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
L2768
|
Orthotic side bar disconnect device, per bar
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
28300
|
PR OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
28309
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L1960
|
HC SUPPLY ANKLE FOOT ORTHOSIS POSTERIOR SOLID ANKLE CUSTOM - L1960
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
28285
|
Repair of hammertoe
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L2300
|
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L2280
|
Molded inner boot
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L2768
|
Orthotic side bar disconnect device, per bar
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
28300
|
PR OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L1960
|
HC SUPPLY ANKLE FOOT ORTHOSIS POSTERIOR SOLID ANKLE CUSTOM - L1960
|
HCPCS
|
DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
|
L2300
|
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
|
HCPCS
|
DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
|
L2280
|
Molded inner boot
|
HCPCS
|
DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
|
L2768
|
Orthotic side bar disconnect device, per bar
|
HCPCS
|
DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
|
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|
|
1745
|
Thoracoscopic robotic assisted procedure
|
ICD
|
PMID 17141745. - World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation.
|
9067
|
Lutetium lu 177 dotatat t
|
APC
|
According to the CDC, flu vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common. For 2019-2020, trivalent (three-component) influenza vaccines contain:
- A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated)
- A/Kansas/14/2017 (H3N2)-like virus (updated)
- B/Colorado/06/2017-like (Victoria lineage) virus
The American Academy of Professional Coders (AAPC) reports that the 2019-20 U.S. quadrivalent influenza vaccines would contain HA derived from these three viruses and an additional influenza B virus HA, a B/Phuket/3073/2013-like virus (Yamagata lineage). Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness.
|
9075
|
Inj, kovaltry, 1 i.u.
|
APC
|
According to the CDC, flu vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common. For 2019-2020, trivalent (three-component) influenza vaccines contain:
- A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated)
- A/Kansas/14/2017 (H3N2)-like virus (updated)
- B/Colorado/06/2017-like (Victoria lineage) virus
The American Academy of Professional Coders (AAPC) reports that the 2019-20 U.S. quadrivalent influenza vaccines would contain HA derived from these three viruses and an additional influenza B virus HA, a B/Phuket/3073/2013-like virus (Yamagata lineage). Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness.
|
9065
|
Argatroban esrd dialysis
|
APC
|
According to the CDC, flu vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common. For 2019-2020, trivalent (three-component) influenza vaccines contain:
- A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated)
- A/Kansas/14/2017 (H3N2)-like virus (updated)
- B/Colorado/06/2017-like (Victoria lineage) virus
The American Academy of Professional Coders (AAPC) reports that the 2019-20 U.S. quadrivalent influenza vaccines would contain HA derived from these three viruses and an additional influenza B virus HA, a B/Phuket/3073/2013-like virus (Yamagata lineage). Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness.
|
9068
|
Smallpox&monkeypox vac 0.
|
APC
|
According to the CDC, flu vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common. For 2019-2020, trivalent (three-component) influenza vaccines contain:
- A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated)
- A/Kansas/14/2017 (H3N2)-like virus (updated)
- B/Colorado/06/2017-like (Victoria lineage) virus
The American Academy of Professional Coders (AAPC) reports that the 2019-20 U.S. quadrivalent influenza vaccines would contain HA derived from these three viruses and an additional influenza B virus HA, a B/Phuket/3073/2013-like virus (Yamagata lineage). Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness.
|
9067
|
Lutetium lu 177 dotatat t
|
APC
|
Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months.
|
9075
|
Inj, kovaltry, 1 i.u.
|
APC
|
Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months.
|
9065
|
Argatroban esrd dialysis
|
APC
|
Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months.
|
9068
|
Smallpox&monkeypox vac 0.
|
APC
|
Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months.
|
9067
|
Lutetium lu 177 dotatat t
|
APC
|
Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”.
|
9075
|
Inj, kovaltry, 1 i.u.
|
APC
|
Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”.
|
9065
|
Argatroban esrd dialysis
|
APC
|
Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”.
|
9068
|
Smallpox&monkeypox vac 0.
|
APC
|
Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations. CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”.
|
9067
|
Lutetium lu 177 dotatat t
|
APC
|
CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”. - “In January 2019, the FDA approved a change in dose volume for Fluzone Quadrivalent (IIV4).
|
9075
|
Inj, kovaltry, 1 i.u.
|
APC
|
CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”. - “In January 2019, the FDA approved a change in dose volume for Fluzone Quadrivalent (IIV4).
|
9065
|
Argatroban esrd dialysis
|
APC
|
CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”. - “In January 2019, the FDA approved a change in dose volume for Fluzone Quadrivalent (IIV4).
|
9068
|
Smallpox&monkeypox vac 0.
|
APC
|
CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness. CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”. - “In January 2019, the FDA approved a change in dose volume for Fluzone Quadrivalent (IIV4).
|
S9345
|
HIT anti-hemophil diem
|
HCPCS
|
BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed.
|
36440
|
PR PUSH TRANSFUSION BLOOD 2 YR OR YOUNGER
|
HCPCS
|
BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed.
|
85244
|
HC CLOTTING; FACTOR VIII (AHG) RELATED ANTIGEN
|
HCPCS
|
BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed.
|
S9345
|
HIT anti-hemophil diem
|
HCPCS
|
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed. BCBSMS information added.
|
36440
|
PR PUSH TRANSFUSION BLOOD 2 YR OR YOUNGER
|
HCPCS
|
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed. BCBSMS information added.
|
85244
|
HC CLOTTING; FACTOR VIII (AHG) RELATED ANTIGEN
|
HCPCS
|
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed. BCBSMS information added.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed. BCBSMS information added.
|
Q2023
|
Xyntha - inj
|
CPT
|
01/01/2009: Accredo preferred provider information removed. BCBSMS information added. 6/30/2009: New HCPC code Q2023 added to covered table. 8/26/2009: Policy statement updated to include medically necessary indications for VIII for routine prophylaxis to reduce the frequency of bleeding episodes and the risk of joint damage in children (0-16) with hemophilia A with no pre-existing joint damage. 12/15/2009: Coding Section revised for 2010 CPT4 and HCPCS revisions
03/08/2010: Description section was updated with Humate-P®, Wilate®.
|
Q2023
|
Xyntha - inj
|
CPT
|
BCBSMS information added. 6/30/2009: New HCPC code Q2023 added to covered table. 8/26/2009: Policy statement updated to include medically necessary indications for VIII for routine prophylaxis to reduce the frequency of bleeding episodes and the risk of joint damage in children (0-16) with hemophilia A with no pre-existing joint damage. 12/15/2009: Coding Section revised for 2010 CPT4 and HCPCS revisions
03/08/2010: Description section was updated with Humate-P®, Wilate®. Also added brand names (ReFacto®, Xyntha® and Advate®) for Factor VIII (recombinant).
|
Q2023
|
Xyntha - inj
|
CPT
|
6/30/2009: New HCPC code Q2023 added to covered table. 8/26/2009: Policy statement updated to include medically necessary indications for VIII for routine prophylaxis to reduce the frequency of bleeding episodes and the risk of joint damage in children (0-16) with hemophilia A with no pre-existing joint damage. 12/15/2009: Coding Section revised for 2010 CPT4 and HCPCS revisions
03/08/2010: Description section was updated with Humate-P®, Wilate®. Also added brand names (ReFacto®, Xyntha® and Advate®) for Factor VIII (recombinant). Policy Section updated with coverage for Von Willebrand disease for Factor VIII.
|
J7185
|
Xyntha inj
|
HCPCS
|
Policy Section updated with coverage for Von Willebrand disease for Factor VIII. Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX."
|
J7187
|
Injection, von willebrand factor complex (humate-p), per iu vwf:rco
|
HCPCS
|
Policy Section updated with coverage for Von Willebrand disease for Factor VIII. Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX."
|
J7184
|
Wilate injection
|
HCPCS
|
Policy Section updated with coverage for Von Willebrand disease for Factor VIII. Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX."
|
J7185
|
Xyntha inj
|
HCPCS
|
Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated.
|
J7187
|
Injection, von willebrand factor complex (humate-p), per iu vwf:rco
|
HCPCS
|
Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated.
|
J7184
|
Wilate injection
|
HCPCS
|
Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated.
|
J7185
|
Xyntha inj
|
HCPCS
|
HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements.
|
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