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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...