code stringlengths 4 12 | description stringlengths 2 264 | codetype stringclasses 8
values | context stringlengths 160 15.5k |
|---|---|---|---|
Q3014 | TELEH ORG SITE FAC FEE Injectable Drugs Not on Fee Schedule | HCPCS | Physicians/practitioners submit the appropriate Current Procedural Terminology (CPT®) procedure code for covered professional telehealth services along with the ‘GT’ modifier (‘via interactive audio and video telecommunications system’). By coding and billing the GT modifier with a covered telehealth procedure code, th... |
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... |
L5857 | Elec knee-shin swing only | HCPCS | Non-covered codes table removed. Covered codes table added. HCPCS L5856, L5857, and L5858 moved to covered. ICD-9 codes 897.2-897.7 and V43.65 added
11/15/2007: Revised policy approved by MPAC
4/27/2010: Title changed from "Prosthetic Knees" to "Prostheses for the Lower Limb." Description section revised to include ank... |
L5858 | Stance phase only | HCPCS | Non-covered codes table removed. Covered codes table added. HCPCS L5856, L5857, and L5858 moved to covered. ICD-9 codes 897.2-897.7 and V43.65 added
11/15/2007: Revised policy approved by MPAC
4/27/2010: Title changed from "Prosthetic Knees" to "Prostheses for the Lower Limb." Description section revised to include ank... |
L5856 | Elec knee-shin swing/stance | HCPCS | Non-covered codes table removed. Covered codes table added. HCPCS L5856, L5857, and L5858 moved to covered. ICD-9 codes 897.2-897.7 and V43.65 added
11/15/2007: Revised policy approved by MPAC
4/27/2010: Title changed from "Prosthetic Knees" to "Prostheses for the Lower Limb." Description section revised to include ank... |
L5857 | Elec knee-shin swing only | HCPCS | Covered codes table added. HCPCS L5856, L5857, and L5858 moved to covered. ICD-9 codes 897.2-897.7 and V43.65 added
11/15/2007: Revised policy approved by MPAC
4/27/2010: Title changed from "Prosthetic Knees" to "Prostheses for the Lower Limb." Description section revised to include ankle-foot prostheses information. P... |
L5858 | Stance phase only | HCPCS | Covered codes table added. HCPCS L5856, L5857, and L5858 moved to covered. ICD-9 codes 897.2-897.7 and V43.65 added
11/15/2007: Revised policy approved by MPAC
4/27/2010: Title changed from "Prosthetic Knees" to "Prostheses for the Lower Limb." Description section revised to include ankle-foot prostheses information. P... |
L5856 | Elec knee-shin swing/stance | HCPCS | Covered codes table added. HCPCS L5856, L5857, and L5858 moved to covered. ICD-9 codes 897.2-897.7 and V43.65 added
11/15/2007: Revised policy approved by MPAC
4/27/2010: Title changed from "Prosthetic Knees" to "Prostheses for the Lower Limb." Description section revised to include ankle-foot prostheses information. P... |
81599 | Unlisted multianalyte assay with algorithmic analysis | CPT | Add to Genetic Testing section. Genetic testing for FMR1 mutations may be considered medically necessary for specific patient populations. Update Coding Section – ICD-10 codes are now effective 10/01/2014. Coding update. CPT codes 83890 – 83913 deleted as of 12/31/12; CPT codes 81200 – 81479 and 81599, effective 1/1/13... |
81599 | Unlisted multianalyte assay with algorithmic analysis | CPT | Update Coding Section – ICD-10 codes are now effective 10/01/2014. Coding update. CPT codes 83890 – 83913 deleted as of 12/31/12; CPT codes 81200 – 81479 and 81599, effective 1/1/13, are added to the policy. Update Related Policies. Add 12.04.91. |
81599 | Unlisted multianalyte assay with algorithmic analysis | CPT | Policy statements and entire policy updated to reflect current DSM-V diagnostic categories, i.e., “intellectual disability” replaces “mental retardation.” Policy statement on testing relatives of affected individuals reworded for clarity. Otherwise, no change to policy statements. CPT code range 81200-81479 and 81599 r... |
81599 | Unlisted multianalyte assay with algorithmic analysis | CPT | Otherwise, no change to policy statements. CPT code range 81200-81479 and 81599 removed; there are specific CPT codes as listed in the policy. ICD-9 and ICD-10 diagnosis codes removed; they do not impact utilization of the policy. Disclaimer: This medical policy is a guide in evaluating the medical necessity of a parti... |
88384 | Eval molecular probes 11-50 | CPT | Neither CancerType ID® nor miRview® (or Rosetta Cancer Origin™) have been submitted to FDA for approval. Gene expression profiling is considered investigational to evaluate the site of origin of a tumor of unknown primary, or to distinguish a primary from a metastatic tumor. Effective in July 2013, there is a specific ... |
88384 | Eval molecular probes 11-50 | CPT | Gene expression profiling is considered investigational to evaluate the site of origin of a tumor of unknown primary, or to distinguish a primary from a metastatic tumor. Effective in July 2013, there is a specific CPT coding for the Pathwork Tissue of Origin test:
81504 - Oncology (tissue of origin), microarray gene e... |
81599 | Unlisted multianalyte assay with algorithmic analysis | CPT | Gene expression profiling is considered investigational to evaluate the site of origin of a tumor of unknown primary, or to distinguish a primary from a metastatic tumor. Effective in July 2013, there is a specific CPT coding for the Pathwork Tissue of Origin test:
81504 - Oncology (tissue of origin), microarray gene e... |
88384 | Eval molecular probes 11-50 | CPT | Effective in July 2013, there is a specific CPT coding for the Pathwork Tissue of Origin test:
81504 - Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores
Prior to July 2013, the preparation ... |
81599 | Unlisted multianalyte assay with algorithmic analysis | CPT | Effective in July 2013, there is a specific CPT coding for the Pathwork Tissue of Origin test:
81504 - Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores
Prior to July 2013, the preparation ... |
81599 | Unlisted multianalyte assay with algorithmic analysis | CPT | Prior to July 2013, Pathwork Diagnostics stated that they used 84999 (unlisted chemistry procedure). The other tests described below do not have specific CPT codes. If the test result is calculated using an algorithm and reported as a numeric score(s) or as a probability, the unlisted multianalyte assays with algorithm... |
81599 | Unlisted multianalyte assay with algorithmic analysis | CPT | The other tests described below do not have specific CPT codes. If the test result is calculated using an algorithm and reported as a numeric score(s) or as a probability, the unlisted multianalyte assays with algorithmic analyses code 81599 would be reported. If not, the unlisted molecular pathology code 81479 would b... |
90850 | nan | CPT | Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. Sep 2011;22 Suppl 6:vi64-68. PMID 21908507
|CPT||81504||Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm re... |
90850 | nan | CPT | Ann Oncol. Sep 2011;22 Suppl 6:vi64-68. PMID 21908507
|CPT||81504||Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores|
|ICD-9 Diagnosis||Investigational for all codes|
|ICD-10-CM (effective ... |
90850 | nan | CPT | Sep 2011;22 Suppl 6:vi64-68. PMID 21908507
|CPT||81504||Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores|
|ICD-9 Diagnosis||Investigational for all codes|
|ICD-10-CM (effective 10/1/15)||I... |
90850 | nan | CPT | PMID 21908507
|CPT||81504||Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as tissue similarity scores|
|ICD-9 Diagnosis||Investigational for all codes|
|ICD-10-CM (effective 10/1/15)||Investigational for all releva... |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | Answers to the “quiz”
Code Source Term 1. 55454-3 LOINC Hemoglobin A1C 2. 250.02 ICD-9-CM Diabetes Mellitus without complications 3. E11.9 ICD-10-CM Type 2 Diabetes Mellitus without Complications 4. 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | 55454-3 LOINC Hemoglobin A1C 2. 250.02 ICD-9-CM Diabetes Mellitus without complications 3. E11.9 ICD-10-CM Type 2 Diabetes Mellitus without Complications 4. 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. 3E013VG ICD-10-PCS Intro of Insulin into SubQ Tissue, Percutaneous Approach 6. |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | 250.02 ICD-9-CM Diabetes Mellitus without complications 3. E11.9 ICD-10-CM Type 2 Diabetes Mellitus without Complications 4. 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. 3E013VG ICD-10-PCS Intro of Insulin into SubQ Tissue, Percutaneous Approach 6. 1-800-783-3637 US Phone Stanley Steemer (1-800-S... |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | E11.9 ICD-10-CM Type 2 Diabetes Mellitus without Complications 4. 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. 3E013VG ICD-10-PCS Intro of Insulin into SubQ Tissue, Percutaneous Approach 6. 1-800-783-3637 US Phone Stanley Steemer (1-800-STEEMER) (go ahead... sing the rest) |
55289-211-60 | METFORMIN HCL 500 MG PO TAB | NDC | 55289-211-60 NDC GLUCOPHAGE 500 MG TABLET [PD-RX PHARM 60ea F/C] 5. 3E013VG ICD-10-PCS Intro of Insulin into SubQ Tissue, Percutaneous Approach 6. 1-800-783-3637 US Phone Stanley Steemer (1-800-STEEMER) (go ahead... sing the rest) |
1500 | New Technology - Level 1 | APC | The American Academy of Professionals Coders (AAPC) provides physician-based coding certification courses, such as CPC certification. The organization offers both classroom and online training, which can be completed in less than 5 months. The course fee is $1500. The American Health Information Management Association ... |
97120 | ELECTRIC CURRENT THERAPY | CPT | The ICD-10 code for joint pain is M79.60. This code is used to indicate joint pain that is not otherwise specified. What is the CPT code for rheumatoid arthritis? There is no CPT code specifically for rheumatoid arthritis. However, there are CPT codes that can be used to bill for services related to rheumatoid arthriti... |
97120 | ELECTRIC CURRENT THERAPY | CPT | This code is used to indicate joint pain that is not otherwise specified. What is the CPT code for rheumatoid arthritis? There is no CPT code specifically for rheumatoid arthritis. However, there are CPT codes that can be used to bill for services related to rheumatoid arthritis, such as the following:
97110 – Arthroce... |
97120 | ELECTRIC CURRENT THERAPY | CPT | What is the CPT code for rheumatoid arthritis? There is no CPT code specifically for rheumatoid arthritis. However, there are CPT codes that can be used to bill for services related to rheumatoid arthritis, such as the following:
97110 – Arthrocentesis, one or more joints
97120 – Arthroscopy, knee, diagnostic
29800 – I... |
97120 | ELECTRIC CURRENT THERAPY | CPT | There is no CPT code specifically for rheumatoid arthritis. However, there are CPT codes that can be used to bill for services related to rheumatoid arthritis, such as the following:
97110 – Arthrocentesis, one or more joints
97120 – Arthroscopy, knee, diagnostic
29800 – Injection, intra-articular, tendon sheath, bursa... |
1745 | Thoracoscopic robotic assisted procedure | ICD | Ref Ares. 2016;3151745:1-42. - [Google Scholar]
- ICD-9-CM to and from ICD-10-CM and ICD-10-PCS Crosswalk or General Equivalence Mappings. 2021. Cambridge: National Bureau of Economic Research; Available from: https://www.nber.org/research/data/icd-9-cm-and-icd-10-cm-and-icd-10-pcs-crosswalk-or-general-equivalence-mapp... |
S9562 | HT inj palivizumab diem | HCPCS | The prescribing physician requests the number of doses/milliliters for Synagis and outlines the pediatric patient’s supporting medical history, which should include the patient’s diagnosed conditions and most importantly, the patient’s weight. The health plan staff, likely the Medical Director, will review and approve ... |
96372 | THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR | HCPCS | The prescribing physician requests the number of doses/milliliters for Synagis and outlines the pediatric patient’s supporting medical history, which should include the patient’s diagnosed conditions and most importantly, the patient’s weight. The health plan staff, likely the Medical Director, will review and approve ... |
90378 | HC RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E | HCPCS | The prescribing physician requests the number of doses/milliliters for Synagis and outlines the pediatric patient’s supporting medical history, which should include the patient’s diagnosed conditions and most importantly, the patient’s weight. The health plan staff, likely the Medical Director, will review and approve ... |
66658-230-01 | PALIVIZUMAB 50 MG/0.5ML IM SOLUTION | NDC | The prescribing physician requests the number of doses/milliliters for Synagis and outlines the pediatric patient’s supporting medical history, which should include the patient’s diagnosed conditions and most importantly, the patient’s weight. The health plan staff, likely the Medical Director, will review and approve ... |
66658-231-01 | PALIVIZUMAB 100 MG/ML IM SOLUTION - 7 MONTHS OF AGE OR GREATER | NDC | The prescribing physician requests the number of doses/milliliters for Synagis and outlines the pediatric patient’s supporting medical history, which should include the patient’s diagnosed conditions and most importantly, the patient’s weight. The health plan staff, likely the Medical Director, will review and approve ... |
S9562 | HT inj palivizumab diem | HCPCS | CPT, HCPCS, and NDC codes associated with Synagis and drug administration [Current for Q4-2022]
|90378||Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each|
|96372||Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular... |
96372 | THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG)_ SUBCUTANEOUS OR INTRAMUSCULAR | HCPCS | CPT, HCPCS, and NDC codes associated with Synagis and drug administration [Current for Q4-2022]
|90378||Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each|
|96372||Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular... |
90378 | HC RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E | HCPCS | CPT, HCPCS, and NDC codes associated with Synagis and drug administration [Current for Q4-2022]
|90378||Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each|
|96372||Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular... |
66658-230-01 | PALIVIZUMAB 50 MG/0.5ML IM SOLUTION | NDC | CPT, HCPCS, and NDC codes associated with Synagis and drug administration [Current for Q4-2022]
|90378||Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each|
|96372||Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular... |
66658-231-01 | PALIVIZUMAB 100 MG/ML IM SOLUTION - 7 MONTHS OF AGE OR GREATER | NDC | CPT, HCPCS, and NDC codes associated with Synagis and drug administration [Current for Q4-2022]
|90378||Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each|
|96372||Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular... |
1749 | Other and unspecified robotic assisted procedure | ICD | Codoxo collected age-to-weight growth charts from the CDC for pediatric patients aged 0-24 months, reviewed studies related to premature births and compensatory growth/gains, and identified the ICD-10 CM codes specific to gestation periods, birth weight, and pediatric patient benchmarks by percentile. Premature births ... |
32856 | Prepare donor lung double | HCPCS | Bronchiolitis obliterans is associated with chronic lung transplant rejection, and thus may be the etiology of a request for lung retransplantation. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by ... |
S2061 | Donor lobectomy (lung) for transplantation, living donor | HCPCS | Bronchiolitis obliterans is associated with chronic lung transplant rejection, and thus may be the etiology of a request for lung retransplantation. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by ... |
32855 | Prepare donor lung single | HCPCS | Bronchiolitis obliterans is associated with chronic lung transplant rejection, and thus may be the etiology of a request for lung retransplantation. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by ... |
S2060 | LOBAR LUNG TRANSPLANTATION | HCPCS | Bronchiolitis obliterans is associated with chronic lung transplant rejection, and thus may be the etiology of a request for lung retransplantation. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by ... |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | Bronchiolitis obliterans is associated with chronic lung transplant rejection, and thus may be the etiology of a request for lung retransplantation. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by ... |
32856 | Prepare donor lung double | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 p... |
S2061 | Donor lobectomy (lung) for transplantation, living donor | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 p... |
32855 | Prepare donor lung single | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 p... |
S2060 | LOBAR LUNG TRANSPLANTATION | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 p... |
S2152 | SOLID ORGAN TRANSPL PKG | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/5/2002: Policy exception deleted
5/1/2002: Type of Service and Place of Service deleted
8/20/2003: ICD-9 p... |
32856 | Prepare donor lung double | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 ... |
S2061 | Donor lobectomy (lung) for transplantation, living donor | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 ... |
32855 | Prepare donor lung single | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 ... |
S2060 | LOBAR LUNG TRANSPLANTATION | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 ... |
S2152 | SOLID ORGAN TRANSPL PKG | HCPCS | Each individual transplant certer will determine patient selection criteria for HIV positive patients"
10/17/2005: Code Reference table updated: CPT codes 32855, 32856 added; ICD-9 procedure code 00.91, 00.92, 00.93 added; HCPCS codes S2060, S2061 S2152 added; diagnosis code 518.3 added
3/14/2006: Coding updated. CPT4 ... |
95251 | PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R | HCPCS | GlucoWatch® G2™ Biographer (G2™ Biographer) information added to Description section. 9/5/2003: Policy reviewed, no changes
10/16/2003: GlucoWatch clarification statement added to "Policy" section
1/27/2004: Sources updated
2/10/2004: Sources updated
11/3/2004: Code Reference section reviewed, no changes
3/13/2006: Cod... |
95250 | PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT | HCPCS | GlucoWatch® G2™ Biographer (G2™ Biographer) information added to Description section. 9/5/2003: Policy reviewed, no changes
10/16/2003: GlucoWatch clarification statement added to "Policy" section
1/27/2004: Sources updated
2/10/2004: Sources updated
11/3/2004: Code Reference section reviewed, no changes
3/13/2006: Cod... |
S1031 | Gluc monitor rental | HCPCS | GlucoWatch® G2™ Biographer (G2™ Biographer) information added to Description section. 9/5/2003: Policy reviewed, no changes
10/16/2003: GlucoWatch clarification statement added to "Policy" section
1/27/2004: Sources updated
2/10/2004: Sources updated
11/3/2004: Code Reference section reviewed, no changes
3/13/2006: Cod... |
95251 | PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R | HCPCS | 9/5/2003: Policy reviewed, no changes
10/16/2003: GlucoWatch clarification statement added to "Policy" section
1/27/2004: Sources updated
2/10/2004: Sources updated
11/3/2004: Code Reference section reviewed, no changes
3/13/2006: Coding updated. CPT4 2006 revisons added to policy
3/20/2006: Policy reviewed, no changes... |
95250 | PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT | HCPCS | 9/5/2003: Policy reviewed, no changes
10/16/2003: GlucoWatch clarification statement added to "Policy" section
1/27/2004: Sources updated
2/10/2004: Sources updated
11/3/2004: Code Reference section reviewed, no changes
3/13/2006: Coding updated. CPT4 2006 revisons added to policy
3/20/2006: Policy reviewed, no changes... |
S1031 | Gluc monitor rental | HCPCS | 9/5/2003: Policy reviewed, no changes
10/16/2003: GlucoWatch clarification statement added to "Policy" section
1/27/2004: Sources updated
2/10/2004: Sources updated
11/3/2004: Code Reference section reviewed, no changes
3/13/2006: Coding updated. CPT4 2006 revisons added to policy
3/20/2006: Policy reviewed, no changes... |
95251 | PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R | HCPCS | CPT4 2006 revisons added to policy
3/20/2006: Policy reviewed, no changes
3/27/2007: Policy reviewed and updated. Covered codes table deleted. CPT codes 95250, 95251, and HCPCS S1031 moved to non-covered. Removed the following policy statement, "Continuous monitoring of glucose in the interstitial fluid is considered i... |
95250 | PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT | HCPCS | CPT4 2006 revisons added to policy
3/20/2006: Policy reviewed, no changes
3/27/2007: Policy reviewed and updated. Covered codes table deleted. CPT codes 95250, 95251, and HCPCS S1031 moved to non-covered. Removed the following policy statement, "Continuous monitoring of glucose in the interstitial fluid is considered i... |
S1031 | Gluc monitor rental | HCPCS | CPT4 2006 revisons added to policy
3/20/2006: Policy reviewed, no changes
3/27/2007: Policy reviewed and updated. Covered codes table deleted. CPT codes 95250, 95251, and HCPCS S1031 moved to non-covered. Removed the following policy statement, "Continuous monitoring of glucose in the interstitial fluid is considered i... |
95251 | PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R | HCPCS | Covered codes table deleted. CPT codes 95250, 95251, and HCPCS S1031 moved to non-covered. Removed the following policy statement, "Continuous monitoring of glucose in the interstitial fluid is considered investigational except for patients with type 1 diabetes who have not achieved adequate glycemic control in spite o... |
95250 | PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT | HCPCS | Covered codes table deleted. CPT codes 95250, 95251, and HCPCS S1031 moved to non-covered. Removed the following policy statement, "Continuous monitoring of glucose in the interstitial fluid is considered investigational except for patients with type 1 diabetes who have not achieved adequate glycemic control in spite o... |
S1031 | Gluc monitor rental | HCPCS | Covered codes table deleted. CPT codes 95250, 95251, and HCPCS S1031 moved to non-covered. Removed the following policy statement, "Continuous monitoring of glucose in the interstitial fluid is considered investigational except for patients with type 1 diabetes who have not achieved adequate glycemic control in spite o... |
0049T | External circulation assist | 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... |
33978 | Remove ventricular device | 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... |
33977 | Remove ventricular device | 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... |
0052T | Replace thrc unit hrt syst | 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... |
33976 | PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR | 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... |
33975 | PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE | 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... |
0050T | Removal circulation assist | 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... |
0053T | Replace implantable hrt syst | 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... |
Q0480 | Driver pneumatic vad, rep | 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... |
0048T | Implant ventricular device | 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... |
0051T | Implant total heart system | 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... |
0049T | External circulation assist | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
33978 | Remove ventricular device | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
33977 | Remove ventricular device | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
0052T | Replace thrc unit hrt syst | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
33976 | PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
33975 | PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
0050T | Removal circulation assist | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
0053T | Replace implantable hrt syst | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
Q0480 | Driver pneumatic vad, rep | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
0048T | Implant ventricular device | 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devic... |
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