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15.5k
E0691
Uvl pnl 2 sq ft or less
HCPCS
POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC) 4/1997: Investigational indication of seasonal affective disorder approved by (MPAC) 8/1999: Revisions approved by MPAC 2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added 5/2/2002: Type of Service...
A4633
Uvl replacement bulb
HCPCS
POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC) 4/1997: Investigational indication of seasonal affective disorder approved by (MPAC) 8/1999: Revisions approved by MPAC 2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added 5/2/2002: Type of Service...
E0690
UV CABINET APPROPRIATE HOME USE
CPT
POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC) 4/1997: Investigational indication of seasonal affective disorder approved by (MPAC) 8/1999: Revisions approved by MPAC 2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added 5/2/2002: Type of Service...
E0693
Uvl sys panel 6 ft
HCPCS
POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC) 4/1997: Investigational indication of seasonal affective disorder approved by (MPAC) 8/1999: Revisions approved by MPAC 2/11/2002: Appeal statement deleted from Policy Exception section, investigational definition added 5/2/2002: Type of Service...
92135
Ophth dx imaging post seg
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
93875
Extracranial study
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
S0820
COMPUTERIZED CORNEAL TOPOGRA
HCPCS
For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of m...
1000
HC ASAM LEVEL 3.7 MEDICALLY MONITORED INPATIENT
RC
The ICD-10 codes are applicable for hospital inpatient procedures. ICD-10-PCS (Procedure Coding System), designed by 3M Health Information Management for Centers of Medicare and Medicaid, is the code set to replace the Volume 3 of ICD-9-CM for inpatient procedure reporting. This ICD-10-PCS has approx. 71000 alpha-numer...
1000
HC ASAM LEVEL 3.7 MEDICALLY MONITORED INPATIENT
RC
ICD-10-PCS (Procedure Coding System), designed by 3M Health Information Management for Centers of Medicare and Medicaid, is the code set to replace the Volume 3 of ICD-9-CM for inpatient procedure reporting. This ICD-10-PCS has approx. 71000 alpha-numeric codes which has seven digits. Structure of ICD-10-PCS Codes: In ...
1000
HC ASAM LEVEL 3.7 MEDICALLY MONITORED INPATIENT
RC
This ICD-10-PCS has approx. 71000 alpha-numeric codes which has seven digits. Structure of ICD-10-PCS Codes: In the structure, For the example shown above, ICD-10 code for knee joint replacement (0SRC0JZ – Replacement of Right Knee Joint with Synthetic Substitute, Open Approach) means the following: For more informatio...
2002
CARDIAC STRUCTURAL & VALVULAR DISORDERS
APR-DRG
Retrospective case-control study. Administrative claims data from 45 academic medical centers. A total of 10,857 patients who developed health care-associated CDI and were discharged between April 1, 2002, and March 31, 2007 (cases); each case patient was matched by hospital, age, quarter and year of hospital discharge...
2002
CARDIAC STRUCTURAL & VALVULAR DISORDERS
APR-DRG
A total of 10,857 patients who developed health care-associated CDI and were discharged between April 1, 2002, and March 31, 2007 (cases); each case patient was matched by hospital, age, quarter and year of hospital discharge, and diagnosis related group to at least one control patient who did not develop health care-a...
2426
PLATE 1/3 TUB W/COLLAR 5H 61MM
CDM
To evaluate whether this truly includes all source codes indicating gangrene, several terms (e.g. “gangrene”) were used to search the descriptions in the CONCEPT and SOURCE_TO_CONCEPT_MAP tables to identify source codes. An automated search is then used to evaluate whether each gangrene source code appearing in the dat...
15878
Suction lipectomy upr extrem
HCPCS
changed from investigational to medically necessary as follows: "Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents. "; "The treatment of axillary hyperhidrosis is considered cosmetic and therefore not eligible for covera...
97033
SBT PTA IONTOPHORESIS EACH 15 MIN
HCPCS
changed from investigational to medically necessary as follows: "Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents. "; "The treatment of axillary hyperhidrosis is considered cosmetic and therefore not eligible for covera...
J0585
PR INJECTION,ONABOTULINUMTOXINA 1 UNITS
HCPCS
changed from investigational to medically necessary as follows: "Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents. "; "The treatment of axillary hyperhidrosis is considered cosmetic and therefore not eligible for covera...
17999
UNLISTED PROC SKIN SUBQ
HCPCS
changed from investigational to medically necessary as follows: "Treatment of severe primary axillary hyperhidrosis with botulinum toxin is considered medically necessary after failed treatment using topical agents. "; "The treatment of axillary hyperhidrosis is considered cosmetic and therefore not eligible for covera...
J0585
PR INJECTION,ONABOTULINUMTOXINA 1 UNITS
HCPCS
01/01/2009: Accredo preferred provider information removed. BCBSMS information added. 07/27/2009: Policy Description section updated for a clearer understanding of primary and secondary hyperhidrosis symptoms and treatments, Policy Statement section revised to add table with treatments considered medically necessary pe...
J0587
rimabotulinumtoxinB 5,000 unit/mL solution 1 mL Vial
HCPCS
01/01/2009: Accredo preferred provider information removed. BCBSMS information added. 07/27/2009: Policy Description section updated for a clearer understanding of primary and secondary hyperhidrosis symptoms and treatments, Policy Statement section revised to add table with treatments considered medically necessary pe...
J0585
PR INJECTION,ONABOTULINUMTOXINA 1 UNITS
HCPCS
BCBSMS information added. 07/27/2009: Policy Description section updated for a clearer understanding of primary and secondary hyperhidrosis symptoms and treatments, Policy Statement section revised to add table with treatments considered medically necessary per region and treatments considered investigational per regio...
J0587
rimabotulinumtoxinB 5,000 unit/mL solution 1 mL Vial
HCPCS
BCBSMS information added. 07/27/2009: Policy Description section updated for a clearer understanding of primary and secondary hyperhidrosis symptoms and treatments, Policy Statement section revised to add table with treatments considered medically necessary per region and treatments considered investigational per regio...
E2120
Pulse gen sys tx endolymp fl
HCPCS
Patients then place an ear-cuff in the external ear canal and treat themselves for 3 minutes, 3 times daily. Treatment is continued for as long as patients find themselves in a period of attacks of vertigo. In 1999, the Meniett® device (Medtronic, Minneapolis, MN) received clearance to market through a U.S. Food and Dr...
E2120
Pulse gen sys tx endolymp fl
HCPCS
In 1999, the Meniett® device (Medtronic, Minneapolis, MN) received clearance to market through a U.S. Food and Drug Administration (FDA) 510(k) process specifically as a symptomatic treatment of Meniere's disease. Transtympanic micropressure applications as a treatment of Meniere`s disease are considered investigationa...
A4638
Repl batt pulse gen sys
HCPCS
2012. Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses| |386.00 – 386.04||Meniere`s disease code range| |HCPCS||A4638||Replacement battery for patient-owned ear generator, each| |E2120||Pulse generator system for t...
E2120
Pulse gen sys tx endolymp fl
HCPCS
2012. Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses| |386.00 – 386.04||Meniere`s disease code range| |HCPCS||A4638||Replacement battery for patient-owned ear generator, each| |E2120||Pulse generator system for t...
A4638
Repl batt pulse gen sys
HCPCS
Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses| |386.00 – 386.04||Meniere`s disease code range| |HCPCS||A4638||Replacement battery for patient-owned ear generator, each| |E2120||Pulse generator system for tympani...
E2120
Pulse gen sys tx endolymp fl
HCPCS
Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses| |386.00 – 386.04||Meniere`s disease code range| |HCPCS||A4638||Replacement battery for patient-owned ear generator, each| |E2120||Pulse generator system for tympani...
A4638
Repl batt pulse gen sys
HCPCS
Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses| |386.00 – 386.04||Meniere`s disease code range| |HCPCS||A4638||Replacement battery for patient-owned ear generator, each| |E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid| |ICD-10-CM (effective 10/1/15)||...
E2120
Pulse gen sys tx endolymp fl
HCPCS
Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses| |386.00 – 386.04||Meniere`s disease code range| |HCPCS||A4638||Replacement battery for patient-owned ear generator, each| |E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid| |ICD-10-CM (effective 10/1/15)||...
A4638
Repl batt pulse gen sys
HCPCS
|ICD-9 Diagnosis||Investigational for all diagnoses| |386.00 – 386.04||Meniere`s disease code range| |HCPCS||A4638||Replacement battery for patient-owned ear generator, each| |E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid| |ICD-10-CM (effective 10/1/15)||Investigational for all d...
E2120
Pulse gen sys tx endolymp fl
HCPCS
|ICD-9 Diagnosis||Investigational for all diagnoses| |386.00 – 386.04||Meniere`s disease code range| |HCPCS||A4638||Replacement battery for patient-owned ear generator, each| |E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid| |ICD-10-CM (effective 10/1/15)||Investigational for all d...
E1340
Repair for DME - per 15 min
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
A4556
PT ELECTRODES
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
1999
ANESTHESIOLOGY GROUP
CPT
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
E0608
APNEA MONITOR
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
A4557
Lead wires, pair
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
E0619
Apnea monitor w recorder
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
E0618
Apnea monitor, without recording feature
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
E1340
Repair for DME - per 15 min
CPT
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies ...
A4556
PT ELECTRODES
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies ...
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. 6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies ...
E0608
APNEA MONITOR
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies ...
A4557
Lead wires, pair
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies ...
E0619
Apnea monitor w recorder
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies ...
E0618
Apnea monitor, without recording feature
HCPCS
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. 6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies ...
E1340
Repair for DME - per 15 min
CPT
6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies merged; interim policy changes made 11/1999: Revisions to interim policy approved by MPAC 2/27/2002: Managed Care Requirements deleted 3/...
A4556
PT ELECTRODES
HCPCS
6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies merged; interim policy changes made 11/1999: Revisions to interim policy approved by MPAC 2/27/2002: Managed Care Requirements deleted 3/...
1999
ANESTHESIOLOGY GROUP
CPT
6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies merged; interim policy changes made 11/1999: Revisions to interim policy approved by MPAC 2/27/2002: Managed Care Requirements deleted 3/...
E0608
APNEA MONITOR
HCPCS
6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies merged; interim policy changes made 11/1999: Revisions to interim policy approved by MPAC 2/27/2002: Managed Care Requirements deleted 3/...
A4557
Lead wires, pair
HCPCS
6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies merged; interim policy changes made 11/1999: Revisions to interim policy approved by MPAC 2/27/2002: Managed Care Requirements deleted 3/...
E0619
Apnea monitor w recorder
HCPCS
6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies merged; interim policy changes made 11/1999: Revisions to interim policy approved by MPAC 2/27/2002: Managed Care Requirements deleted 3/...
E0618
Apnea monitor, without recording feature
HCPCS
6/1992: Pneumogram policy approved by Medical Policy Advisory Committee (MPAC) 8/1992: Home Apnea Monitor policy approved by Medical Policy Advisory Committee (MPAC) 9/1999: Policies merged; interim policy changes made 11/1999: Revisions to interim policy approved by MPAC 2/27/2002: Managed Care Requirements deleted 3/...
87476
LYME DISEASE PCR
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
87477
Lyme dis dna quant
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
87475
Lyme dis dna dir probe
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
87476
LYME DISEASE PCR
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 HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disea...
87477
Lyme dis dna quant
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 HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disea...
87475
Lyme dis dna dir probe
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 HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disea...
J0550
Penicillin g benzathine inj
HCPCS
POLICY HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disease Treatment” renamed “Intravenous Antiobiotic Therapy for Lyme Disease”, Description and Policy sections revised to be consistent with B...
J0540
Penicillin g benzathine inj
HCPCS
POLICY HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disease Treatment” renamed “Intravenous Antiobiotic Therapy for Lyme Disease”, Description and Policy sections revised to be consistent with B...
87476
LYME DISEASE PCR
HCPCS
POLICY HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disease Treatment” renamed “Intravenous Antiobiotic Therapy for Lyme Disease”, Description and Policy sections revised to be consistent with B...
J0530
Penicillin g benzathine inj
HCPCS
POLICY HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disease Treatment” renamed “Intravenous Antiobiotic Therapy for Lyme Disease”, Description and Policy sections revised to be consistent with B...
87477
Lyme dis dna quant
HCPCS
POLICY HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disease Treatment” renamed “Intravenous Antiobiotic Therapy for Lyme Disease”, Description and Policy sections revised to be consistent with B...
87475
Lyme dis dna dir probe
HCPCS
POLICY HISTORY1/1994: Approved by Medical Policy Advisory Committee (MPAC) 5/1/2002: Type of Service and Place of Service deleted 3/25/2004: Reviewed by MPAC, Policy title “Lyme Disease Treatment” renamed “Intravenous Antiobiotic Therapy for Lyme Disease”, Description and Policy sections revised to be consistent with B...
J0550
Penicillin g benzathine inj
HCPCS
Policy statement revised; IV antibiotic therapy is not medically necessary for uncomplicated cranial nerve palsy associated with Lyme disease and antibiotic-refractory Lyme arthritis 7/19/2007: Reviewed and approved by MPAC 7/10/2009: Policy reviewed, no changes 12/15/2009: Coding Section revised with 2010 CPT4 and HCP...
J0540
Penicillin g benzathine inj
HCPCS
Policy statement revised; IV antibiotic therapy is not medically necessary for uncomplicated cranial nerve palsy associated with Lyme disease and antibiotic-refractory Lyme arthritis 7/19/2007: Reviewed and approved by MPAC 7/10/2009: Policy reviewed, no changes 12/15/2009: Coding Section revised with 2010 CPT4 and HCP...
J0530
Penicillin g benzathine inj
HCPCS
Policy statement revised; IV antibiotic therapy is not medically necessary for uncomplicated cranial nerve palsy associated with Lyme disease and antibiotic-refractory Lyme arthritis 7/19/2007: Reviewed and approved by MPAC 7/10/2009: Policy reviewed, no changes 12/15/2009: Coding Section revised with 2010 CPT4 and HCP...
J0550
Penicillin g benzathine inj
HCPCS
No changes to other policy statements. Removed deleted HCPCS codes J0530, J0540, and J0550 from the Code Reference section. 02/24/2012: Add the following policy statement: A single 2- to 4-week course of IV antibiotics may be considered medically necessary in patients with Lyme carditis, as evidenced by positive serolo...
J0540
Penicillin g benzathine inj
HCPCS
No changes to other policy statements. Removed deleted HCPCS codes J0530, J0540, and J0550 from the Code Reference section. 02/24/2012: Add the following policy statement: A single 2- to 4-week course of IV antibiotics may be considered medically necessary in patients with Lyme carditis, as evidenced by positive serolo...
J0530
Penicillin g benzathine inj
HCPCS
No changes to other policy statements. Removed deleted HCPCS codes J0530, J0540, and J0550 from the Code Reference section. 02/24/2012: Add the following policy statement: A single 2- to 4-week course of IV antibiotics may be considered medically necessary in patients with Lyme carditis, as evidenced by positive serolo...
J0580
Penicillin g benzathine inj
HCPCS
It previously stated that determination of levels of the B lymphocyte chemoattractant CXCL13 for diagnosis or monitoring treatment is considered investigational. Deleted outdated references from the Sources section. 11/28/2012: Policy reviewed; no changes. 03/10/2014: Policy reviewed; no changes to policy statement. Re...
J0560
Penicillin g benzathine inj
HCPCS
It previously stated that determination of levels of the B lymphocyte chemoattractant CXCL13 for diagnosis or monitoring treatment is considered investigational. Deleted outdated references from the Sources section. 11/28/2012: Policy reviewed; no changes. 03/10/2014: Policy reviewed; no changes to policy statement. Re...
J0570
Buprenorphine implant, 74.2 mg
HCPCS
It previously stated that determination of levels of the B lymphocyte chemoattractant CXCL13 for diagnosis or monitoring treatment is considered investigational. Deleted outdated references from the Sources section. 11/28/2012: Policy reviewed; no changes. 03/10/2014: Policy reviewed; no changes to policy statement. Re...
J0580
Penicillin g benzathine inj
HCPCS
11/28/2012: Policy reviewed; no changes. 03/10/2014: Policy reviewed; no changes to policy statement. Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoatt...
J0560
Penicillin g benzathine inj
HCPCS
11/28/2012: Policy reviewed; no changes. 03/10/2014: Policy reviewed; no changes to policy statement. Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoatt...
J0570
Buprenorphine implant, 74.2 mg
HCPCS
11/28/2012: Policy reviewed; no changes. 03/10/2014: Policy reviewed; no changes to policy statement. Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoatt...
J0561
PR PENICILLIN G BENZATHINE INJ 100,000 UNITS
HCPCS
11/28/2012: Policy reviewed; no changes. 03/10/2014: Policy reviewed; no changes to policy statement. Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoatt...
J0580
Penicillin g benzathine inj
HCPCS
03/10/2014: Policy reviewed; no changes to policy statement. Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoattractant CXCL13. Medically necessary polic...
J0560
Penicillin g benzathine inj
HCPCS
03/10/2014: Policy reviewed; no changes to policy statement. Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoattractant CXCL13. Medically necessary polic...
J0570
Buprenorphine implant, 74.2 mg
HCPCS
03/10/2014: Policy reviewed; no changes to policy statement. Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoattractant CXCL13. Medically necessary polic...
J0561
PR PENICILLIN G BENZATHINE INJ 100,000 UNITS
HCPCS
03/10/2014: Policy reviewed; no changes to policy statement. Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoattractant CXCL13. Medically necessary polic...
J0580
Penicillin g benzathine inj
HCPCS
Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoattractant CXCL13. Medically necessary policy statement regarding PCR-based direct detection of B. burgdo...
J0560
Penicillin g benzathine inj
HCPCS
Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoattractant CXCL13. Medically necessary policy statement regarding PCR-based direct detection of B. burgdo...
J0570
Buprenorphine implant, 74.2 mg
HCPCS
Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoattractant CXCL13. Medically necessary policy statement regarding PCR-based direct detection of B. burgdo...
J0561
PR PENICILLIN G BENZATHINE INJ 100,000 UNITS
HCPCS
Removed deleted HCPCS codes J0560, J0570, and J0580 from the Code Reference section. Added HCPCS code J0561. 02/18/2015: Policy description updated regarding polymerase chain reaction and the evaluation of the Chemoattractant CXCL13. Medically necessary policy statement regarding PCR-based direct detection of B. burgdo...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
CPT is used by insurance companies to determine how much physicians will be paid for their services. HCPCS – Healthcare Common Procedure Coding System is a set of health care procedure codes based on the AMA’s CPT system. HCPCS is a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). T...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
HCPCS is a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). This coding system was created to standardize the coding of specific items and services proved by health care professionals and billed to Medicare and Medicaid. The HIPAA Act of 1996 made the use of HCPCS coding mandatory f...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
This coding system was created to standardize the coding of specific items and services proved by health care professionals and billed to Medicare and Medicaid. The HIPAA Act of 1996 made the use of HCPCS coding mandatory for processing insurance claims through Medicare and Medicaid. It includes circumstances and proce...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
CMS is considering phasing out HCPCS. There are 3 levels within HCPCS: HCPCS Level 1 Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index). HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable ...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
There are 3 levels within HCPCS: HCPCS Level 1 Consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric (as opposed to alphabetic like the index). HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCP...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
HCPCS Level 2 Level 2 consists of non-physician services such as ambulatory care and durable medical goods such as prosthetics. HCPCS Level 3 Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on Decemb...
1996
Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration
HCPCS
HCPCS Level 3 Level 3 consisted of state-level medical coding codesets. The HIPAA Act of 1996 required a nationwide standard for medical coding. As a result, level 3 was discontinued on December 31, 2003. Current Procedural Terminology (CPT) is an outpatient medical coding codeset that is copy-written by the American M...
G0358
IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
G0360
Each additional hr 1-8 hrs
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
G0363
IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
J9000
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
G0364
HC BONE MARROW ASPIRATE & BIOPSY
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
G0362
Each add sequential infusion
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
J9999
Not otherwise classified, antineoplastic drugs
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...
G0359
Chemotherapy IV one hr initi
HCPCS
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology mus...