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90756
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
HCPCS
|
- Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses.
|
G0008
|
PR ADMIN INFLUENZA VIRUS VAC
|
HCPCS
|
- Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses.
|
9068
|
Smallpox&monkeypox vac 0.
|
APC
|
- Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses.
|
90689
|
HC IIV4 VACC INACTIVATED PRSRV FR 0.25ML DOS IM US
|
HCPCS
|
- Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses.
|
90686
|
INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, PRESERVATIVE FREE, 0.5 ML DOSAGE, FOR INTRAMUSCULAR USE
|
HCPCS
|
- Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses.
|
90682
|
HC RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
HCPCS
|
- Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses.
|
2035
|
Auto cell process sys
|
APC
|
- Intradermal flu vaccines will not be available. - The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses.
|
90674
|
HC CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90653
|
HC FLU VACCINE ADJUVANT IM
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
9065
|
Argatroban esrd dialysis
|
APC
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
9067
|
Lutetium lu 177 dotatat t
|
APC
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90662
|
INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE, ENHANCED IMMUNOGENICITY VIA INCREASED ANTIGEN CONTENT, FOR INTRAMUSCULAR USE
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90685
|
HC IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90656
|
HC IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
9075
|
Inj, kovaltry, 1 i.u.
|
APC
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
Q2035
|
PR AFLURIA VACC, 3 YRS & >, IM
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90688
|
HC IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90687
|
Iiv4 vaccine splt 0.25 ml im
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90756
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
G0008
|
PR ADMIN INFLUENZA VIRUS VAC
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
9068
|
Smallpox&monkeypox vac 0.
|
APC
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90689
|
HC IIV4 VACC INACTIVATED PRSRV FR 0.25ML DOS IM US
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90686
|
INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, PRESERVATIVE FREE, 0.5 ML DOSAGE, FOR INTRAMUSCULAR USE
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
90682
|
HC RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
HCPCS
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
2035
|
Auto cell process sys
|
APC
|
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019. Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019. 2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year.
|
B4105
|
Enzyme cartridge enteral nut
|
HCPCS
|
- The latest updates include 279 new codes, 51 deleted codes, and 143 revised codes. A total of 71,932 active codes have been recorded with the most recent CMS revisions. - Chapters 1, 3 and 8 witnessed no new changes whereas chapter 2,7,11,14,15,16 and 19 went through the highest changes. - HCPCS codes overhaul
- CMS has also changed HCPCS codes Q9994, effective December 3, 2018. - The HCPCS code B4105 is changed from D "Special Coverage Instructions Apply" to C "Contractor Discretion.
|
B4105
|
Enzyme cartridge enteral nut
|
HCPCS
|
A total of 71,932 active codes have been recorded with the most recent CMS revisions. - Chapters 1, 3 and 8 witnessed no new changes whereas chapter 2,7,11,14,15,16 and 19 went through the highest changes. - HCPCS codes overhaul
- CMS has also changed HCPCS codes Q9994, effective December 3, 2018. - The HCPCS code B4105 is changed from D "Special Coverage Instructions Apply" to C "Contractor Discretion. Code B4105 replaces code Q9994 effective for claims with dates of service on or after January 1, 2019.
|
B4105
|
Enzyme cartridge enteral nut
|
HCPCS
|
- Chapters 1, 3 and 8 witnessed no new changes whereas chapter 2,7,11,14,15,16 and 19 went through the highest changes. - HCPCS codes overhaul
- CMS has also changed HCPCS codes Q9994, effective December 3, 2018. - The HCPCS code B4105 is changed from D "Special Coverage Instructions Apply" to C "Contractor Discretion. Code B4105 replaces code Q9994 effective for claims with dates of service on or after January 1, 2019. With the latest Live healthcare webinars, SymposiumGo is bringing you all the latest updates related to the most recent changes in the coding environment as well as other healthcare topics.
|
B4105
|
Enzyme cartridge enteral nut
|
HCPCS
|
- HCPCS codes overhaul
- CMS has also changed HCPCS codes Q9994, effective December 3, 2018. - The HCPCS code B4105 is changed from D "Special Coverage Instructions Apply" to C "Contractor Discretion. Code B4105 replaces code Q9994 effective for claims with dates of service on or after January 1, 2019. With the latest Live healthcare webinars, SymposiumGo is bringing you all the latest updates related to the most recent changes in the coding environment as well as other healthcare topics.
|
1744
|
Endoscopic robotic assisted procedure
|
ICD
|
2009, 30 (6): 1297-1305. 10.1016/j.ridd.2009.05.006.PubMedView ArticleGoogle Scholar
- World Health Organization (WHO): International Classification of Diseases; tenth Edition (ICD-10) Diagnostic Criteria for Research. 1993, WHO GenevaGoogle Scholar
- Bakare MO, Ubochi VN, Okoroikpa IN, Aguocha CM, Ebigbo PO: Agreement between clinicians' and care givers' assessment of intelligence in Nigerian children with intellectual disability: 'ratio I.Q' as a viable option in the absence of standardized 'deviance IQ'tests in sub-Saharan Africa. Behav and Brain Funct. 2009, 5: 39-10.1186/1744-9081-5-39.View ArticleGoogle Scholar
- Goodman R: The Strengths and Difficulties Questionnaire: a research note.
|
E0485
|
Oral device/appliance prefab
|
HCPCS
|
To qualify for coverage, the OAT service provided must be reasonable and medically necessary and in compliance with all Medicare coverage, coding, and billing requirements. Codes that are used to report OAT include the following. HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes.
|
E0486
|
Oral device/appliance cusfab
|
HCPCS
|
To qualify for coverage, the OAT service provided must be reasonable and medically necessary and in compliance with all Medicare coverage, coding, and billing requirements. Codes that are used to report OAT include the following. HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes.
|
A9270
|
NON-COVERED ITEM OR SERVICE
|
HCPCS
|
To qualify for coverage, the OAT service provided must be reasonable and medically necessary and in compliance with all Medicare coverage, coding, and billing requirements. Codes that are used to report OAT include the following. HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes.
|
E0485
|
Oral device/appliance prefab
|
HCPCS
|
Codes that are used to report OAT include the following. HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33.
|
E0486
|
Oral device/appliance cusfab
|
HCPCS
|
Codes that are used to report OAT include the following. HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33.
|
A9270
|
NON-COVERED ITEM OR SERVICE
|
HCPCS
|
Codes that are used to report OAT include the following. HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33.
|
E0485
|
Oral device/appliance prefab
|
HCPCS
|
HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33. - G47.33 Obstructive sleep apnea (adult) (pediatric)
Documentation and denial management
To substantiate the medical necessity for the oral appliance ordered, dental professionals must obtain the copies of their office notes, pertinent test reports, and other healthcare records from physicians.
|
E0486
|
Oral device/appliance cusfab
|
HCPCS
|
HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33. - G47.33 Obstructive sleep apnea (adult) (pediatric)
Documentation and denial management
To substantiate the medical necessity for the oral appliance ordered, dental professionals must obtain the copies of their office notes, pertinent test reports, and other healthcare records from physicians.
|
A9270
|
NON-COVERED ITEM OR SERVICE
|
HCPCS
|
HCPCS codes and modifiers
Code E0486 may only be used for custom-fabricated mandibular advancement devices. - E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33. - G47.33 Obstructive sleep apnea (adult) (pediatric)
Documentation and denial management
To substantiate the medical necessity for the oral appliance ordered, dental professionals must obtain the copies of their office notes, pertinent test reports, and other healthcare records from physicians.
|
E0485
|
Oral device/appliance prefab
|
HCPCS
|
- E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33. - G47.33 Obstructive sleep apnea (adult) (pediatric)
Documentation and denial management
To substantiate the medical necessity for the oral appliance ordered, dental professionals must obtain the copies of their office notes, pertinent test reports, and other healthcare records from physicians. - To fulfill Medicare requirements, the information in the medical record should include evidence that the treating physician conducted a face-to-face clinical evaluation prior to the sleep study to assess the patient for obstructive sleep apnea.
|
E0486
|
Oral device/appliance cusfab
|
HCPCS
|
- E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33. - G47.33 Obstructive sleep apnea (adult) (pediatric)
Documentation and denial management
To substantiate the medical necessity for the oral appliance ordered, dental professionals must obtain the copies of their office notes, pertinent test reports, and other healthcare records from physicians. - To fulfill Medicare requirements, the information in the medical record should include evidence that the treating physician conducted a face-to-face clinical evaluation prior to the sleep study to assess the patient for obstructive sleep apnea.
|
A9270
|
NON-COVERED ITEM OR SERVICE
|
HCPCS
|
- E0486 – Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
In terms of Medicare reimbursement, HCPCS code E0486 is the only reimbursable code for oral appliance therapy for OSA. Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33. - G47.33 Obstructive sleep apnea (adult) (pediatric)
Documentation and denial management
To substantiate the medical necessity for the oral appliance ordered, dental professionals must obtain the copies of their office notes, pertinent test reports, and other healthcare records from physicians. - To fulfill Medicare requirements, the information in the medical record should include evidence that the treating physician conducted a face-to-face clinical evaluation prior to the sleep study to assess the patient for obstructive sleep apnea.
|
E0485
|
Oral device/appliance prefab
|
HCPCS
|
Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33. - G47.33 Obstructive sleep apnea (adult) (pediatric)
Documentation and denial management
To substantiate the medical necessity for the oral appliance ordered, dental professionals must obtain the copies of their office notes, pertinent test reports, and other healthcare records from physicians. - To fulfill Medicare requirements, the information in the medical record should include evidence that the treating physician conducted a face-to-face clinical evaluation prior to the sleep study to assess the patient for obstructive sleep apnea. The clinical evaluation should be documented in a detailed narrative note in the patient’s chart in the format that the physician uses for other entries.
|
A9270
|
NON-COVERED ITEM OR SERVICE
|
HCPCS
|
Other HCPCS codes – A9270, E0485, and E1399 are not payable codes, but rather only billable codes. HCPCS modifiers for oral appliance therapy may include:
- KX: Requirements specified in the medical policy have been met
- EY: No physician order, or other licensed health care provider order, for this item or service
- GA: Waiver of liability statement issued, as required by payer policy (Item or service expected to be denied as not reasonable and necessary; Advance Beneficiary Notice of Non-coverage on file)
- GZ: Item or service expected to be denied as not reasonable and necessary (No Advance Beneficiary Notice of Non-coverage on file)
- NU: Purchase of new equipment
According to the American Academy of Dental Sleep Medicine, the only ICD-10-CM code that supports medical necessity of oral appliance therapy is: G47.33. - G47.33 Obstructive sleep apnea (adult) (pediatric)
Documentation and denial management
To substantiate the medical necessity for the oral appliance ordered, dental professionals must obtain the copies of their office notes, pertinent test reports, and other healthcare records from physicians. - To fulfill Medicare requirements, the information in the medical record should include evidence that the treating physician conducted a face-to-face clinical evaluation prior to the sleep study to assess the patient for obstructive sleep apnea. The clinical evaluation should be documented in a detailed narrative note in the patient’s chart in the format that the physician uses for other entries.
|
87635
|
SARS-COV-2 COVID-19 AMP PRB
|
HCPCS
|
For instance, the first new code — 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique — was published and effective March 13, 2020. The vaccine and immunization codes may include a note indicating they are effective once the vaccine receives Emergency Use Authorization or approval from the Food and Drug Administration. The AMA posts new codes on its COVID-19 Coding and Guidance page. The page also includes links to CPT® Assistant guides for many of the codes. HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
The AMA posts new codes on its COVID-19 Coding and Guidance page. The page also includes links to CPT® Assistant guides for many of the codes. HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
The AMA posts new codes on its COVID-19 Coding and Guidance page. The page also includes links to CPT® Assistant guides for many of the codes. HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. Dates of service for these codes can go back to Feb. 4, 2020. Healthcare organizations also need to watch for changes to medical coding modifiers.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
HCPCS Level II Codes for SARS-CoV-2/COVID-19 Services
Medicare has released HCPCS Level II codes in response to the COVID-19 pandemic, covering services such as specimen collection and testing. Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. Dates of service for these codes can go back to Feb. 4, 2020. Healthcare organizations also need to watch for changes to medical coding modifiers.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. Dates of service for these codes can go back to Feb. 4, 2020. Healthcare organizations also need to watch for changes to medical coding modifiers. A case in point is modifier CS Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
Check with non-Medicare payers to confirm their policies on use and coverage of these codes. As an example, two HCPCS Level II codes for COVID-19 testing (U0001 and U0002) had an implementation date of April 1, 2020, which is when Medicare claims processing systems were able to accept the codes. Dates of service for these codes can go back to Feb. 4, 2020. Healthcare organizations also need to watch for changes to medical coding modifiers. A case in point is modifier CS Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
POLICY GUIDELINESInvestigative 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 or 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 medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated.
|
S2120
|
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
|
HCPCS
|
POLICY GUIDELINESInvestigative 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 or 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 medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated.
|
36511
|
PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS
|
HCPCS
|
POLICY GUIDELINESInvestigative 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 or 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 medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated.
|
36513
|
PR THERAPEUTIC APHERESIS PLATELETS
|
HCPCS
|
POLICY GUIDELINESInvestigative 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 or 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 medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated.
|
36512
|
PR THERAPEUTIC APHERESIS RED BLOOD CELLS
|
HCPCS
|
POLICY GUIDELINESInvestigative 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 or 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 medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated.
|
36521
|
USE 36516
|
HCPCS
|
POLICY GUIDELINESInvestigative 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 or 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 medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated.
|
36520
|
SEE 36511-36512
|
HCPCS
|
POLICY GUIDELINESInvestigative 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 or 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 medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
|
S2120
|
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
|
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 HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
|
36511
|
PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS
|
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 HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
|
36513
|
PR THERAPEUTIC APHERESIS PLATELETS
|
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 HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
|
36512
|
PR THERAPEUTIC APHERESIS RED BLOOD CELLS
|
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 HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
|
36521
|
USE 36516
|
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 HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
|
36520
|
SEE 36511-36512
|
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 HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
|
S2120
|
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
|
HCPCS
|
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
|
36511
|
PR THERAPEUTIC APHERESIS WHITE BLOOD CELLS
|
HCPCS
|
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
|
36513
|
PR THERAPEUTIC APHERESIS PLATELETS
|
HCPCS
|
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
|
36512
|
PR THERAPEUTIC APHERESIS RED BLOOD CELLS
|
HCPCS
|
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
|
36521
|
USE 36516
|
HCPCS
|
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
|
36520
|
SEE 36511-36512
|
HCPCS
|
POLICY HISTORY6/1993: Therapeutic Apheresis approved by Medical Policy Advisory Committee (MPAC)
11/1993: Extracorporeal Immunoadsorption Using Protein A Columns approved by MPAC
5/1999: MPAC reviewed policies; updated, combined and renamed
12/1999: Interim revision; new FDA-approved indication added for some stages of rheumatoid arthritis
2/2000: Interim revisions approved by MPAC
4/11/2001: Photopheresis for human heart transplant recipients at high risk for fatal rejection
8/2001: Reviewed by MPAC
2/13/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
10/4/2002: ICD-9 procedure code 99.76 added
3/5/2003: Code Reference section updated
7/2003: Reviewed by MPAC, policy aligned to be consistent with BCBSA, Sources updated
3/17/2004: Code Reference section updated, CPT code 36520, 36521 deleted, ICD-9 diagnosis code 203.0, 273.2, 282.8, 284.8, 356.3, 356.9, 358.00 (note 358.0 was covered), 391.1, 710.1, 710.4 deleted, HCPCS Q0068 deleted, ICD-9 diagnosis 642.5 fifth digit added
10/22/2004: Code Reference section updated, CPT 36511, 36512, 36513 deleted, ICD-9 diagnosis 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 272.0, 272.2, 273.0, 273.3, 283.11, 287.3, 287.4, 289.0, 341.0, 341.1, 341.8, 341.9, 357.0, 357.81, 358.01, 446.21, 446.6, 583.81, 642.50, 642.51, 642.52, 642.53, 642.54, 714.0, 714.1, 714.2, 714.30, 714.31, 714.32, 714.33, 714.4, 714.81, 714.89, 714.9, 996.83, E878.0 note added, ICD-9 diagnosis 340 deleted, HCPCS S2120 added
11/7/2005: Code Reference section updated, 5th digit added to ICD9 diagnosis code 287.31
3/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy
7/27/2006: Policy updated. Updates approved per Medical Policy Advisory Committee (MPAC)
8/31/2006: Code Reference section updated. V42.0, V42.1,V42.6, V42.7, V42.81, V42.83 added to covered table
5/1/2008: Policy description updated with acute and chronic conditions; photopheresis, extracorporeal immunoadsorption, and lipid apheresis removed from policy. IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication.
|
36522
|
PR PHOTOPHERESIS EXTRACORPOREAL
|
HCPCS
|
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
|
S2120
|
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
|
HCPCS
|
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
|
86960
|
HC VOL REDUC BLD/PRD EA UN
|
HCPCS
|
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
|
36516
|
PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION
|
HCPCS
|
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
|
36515
|
Apheresis adsorp/reinfuse
|
HCPCS
|
IgA or IgG paraproteinemia polyneuropathy added as a medically necessary indication. Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC.
|
36522
|
PR PHOTOPHERESIS EXTRACORPOREAL
|
HCPCS
|
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
|
S2120
|
Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
|
HCPCS
|
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
|
86960
|
HC VOL REDUC BLD/PRD EA UN
|
HCPCS
|
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
|
36516
|
PR THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION
|
HCPCS
|
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
|
36515
|
Apheresis adsorp/reinfuse
|
HCPCS
|
Inclusion body myositis and asthma added as investigational. Code reference section reviewed; CPT codes 36515, 36516, 36522, 86960 removed; ICD-9 procedure codes 99.76, 99.88 removed; ICD-9 diagnosis codes 202.20-202.28, 272.0-272.2, 714.0-714.9 removed; HCPCS S2120 removed. ICD-9 diagnosis codes 203.00, 203.01, 341.0, 341.20-341.22, 996.81, 996.82, 996.84-996.85 added
9/11/2008: Annual ICD-9 updates applied
06/23/2010: Policy Title changed, removed "Plasmapheresis." Policy Description section was revised for multiple reasons: definitions of apheresis, plasmapheresis and plasma exchange was added; addition applications of PE related to cryoglobulinemia, PANDAS and SC. Policy Statements (medically necessary and investigational) were revised to include conditions that may be considered medically necessary and conditions that are considered investigational.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
- Lower respiratory infection: If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, this should be assigned with code J22, Unspecified acute lower respiratory infection, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere. - Suspected exposure with persons confirmed to have COVID-19: Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. - Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
- Suspected exposure with persons confirmed to have COVID-19: Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. - Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
- Suspected exposure with persons confirmed to have COVID-19: Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. - Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
- Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets).
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
- Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets).
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
- Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
- Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828).
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828).
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828). It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828). It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020. CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828). It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020. CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. CMS has indicated that the Medicare claims processing system will be able to accept HCPCS code U0001 on April 1, 2020 for dates of service on or after February 4, 2020.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828). It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020. CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. CMS has indicated that the Medicare claims processing system will be able to accept HCPCS code U0001 on April 1, 2020 for dates of service on or after February 4, 2020. LBMC is monitoring the latest news from the Center for Medicare and Medicaid Services (CMS), the Centers for Disease Control (CDC), the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) in addition to the American Hospital Association (AHA) Coding Clinic for any official coding advice relating to the novel coronavirus.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020. CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. CMS has indicated that the Medicare claims processing system will be able to accept HCPCS code U0001 on April 1, 2020 for dates of service on or after February 4, 2020. LBMC is monitoring the latest news from the Center for Medicare and Medicaid Services (CMS), the Centers for Disease Control (CDC), the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) in addition to the American Hospital Association (AHA) Coding Clinic for any official coding advice relating to the novel coronavirus. Jenny Harvey is a manager in the Healthcare Consulting division of LBMC.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. CMS has indicated that the Medicare claims processing system will be able to accept HCPCS code U0001 on April 1, 2020 for dates of service on or after February 4, 2020. LBMC is monitoring the latest news from the Center for Medicare and Medicaid Services (CMS), the Centers for Disease Control (CDC), the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) in addition to the American Hospital Association (AHA) Coding Clinic for any official coding advice relating to the novel coronavirus. Jenny Harvey is a manager in the Healthcare Consulting division of LBMC. She holds numerous certification and is an AHIMA-approved ICD-10-CM/PCS trainer.
|
1996
|
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
|
HCPCS
|
HCPCS Level III contains alphanumeric codes that are assigned
by Medicaid state agencies to identify additional items
and services not included in levels I or II. These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three levels, with the WA - ZY range used for locally
assigned procedure modifiers. - Health Insurance Portability &
Accountability Act (HIPAA) – A law passed
in 1996 which is also sometimes called the “Kassebaum-Kennedy”
law. This law expands healthcare coverage for patients who
have lost or changed jobs, or have pre-existing conditions.
|
1996
|
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
|
HCPCS
|
These are usually
called "local codes", and must have "W",
"X", "Y", or "Z" in the first
position. HCPCS Procedure Modifier Codes can be used with
all three levels, with the WA - ZY range used for locally
assigned procedure modifiers. - Health Insurance Portability &
Accountability Act (HIPAA) – A law passed
in 1996 which is also sometimes called the “Kassebaum-Kennedy”
law. This law expands healthcare coverage for patients who
have lost or changed jobs, or have pre-existing conditions. HIPAA does not replace the states' roles as primary regulators
of insurance.
|
96115
|
Neurobehavior status exam
|
HCPCS
|
References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
|
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