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|---|---|---|---|
96115
|
Neurobehavior status exam
|
HCPCS
|
References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
|
96117
|
NEUROPSYCH TEST BATTERY
|
CPT
|
References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
|
96115
|
Neurobehavior status exam
|
HCPCS
|
References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing|
|
96117
|
NEUROPSYCH TEST BATTERY
|
CPT
|
References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing|
|
G6015
|
Radiation tx delivery imrt
|
HCPCS
|
Second medically necessary policy statement revised to change "is" to "may be." Added the following statement: Intensity-modulated radiation therapy is not medically necessary for the treatment of thyroid cancers for all indications not meeting the criteria above. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes.
|
77386
|
HC IMRT COMPLEX
|
HCPCS
|
Second medically necessary policy statement revised to change "is" to "may be." Added the following statement: Intensity-modulated radiation therapy is not medically necessary for the treatment of thyroid cancers for all indications not meeting the criteria above. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes.
|
77385
|
HC IMRT SIMPLE
|
HCPCS
|
Second medically necessary policy statement revised to change "is" to "may be." Added the following statement: Intensity-modulated radiation therapy is not medically necessary for the treatment of thyroid cancers for all indications not meeting the criteria above. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes.
|
G6016
|
PR DELIVERY COMP IMRT
|
HCPCS
|
Second medically necessary policy statement revised to change "is" to "may be." Added the following statement: Intensity-modulated radiation therapy is not medically necessary for the treatment of thyroid cancers for all indications not meeting the criteria above. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes.
|
G6015
|
Radiation tx delivery imrt
|
HCPCS
|
Added the following statement: Intensity-modulated radiation therapy is not medically necessary for the treatment of thyroid cancers for all indications not meeting the criteria above. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section.
|
77386
|
HC IMRT COMPLEX
|
HCPCS
|
Added the following statement: Intensity-modulated radiation therapy is not medically necessary for the treatment of thyroid cancers for all indications not meeting the criteria above. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section.
|
77385
|
HC IMRT SIMPLE
|
HCPCS
|
Added the following statement: Intensity-modulated radiation therapy is not medically necessary for the treatment of thyroid cancers for all indications not meeting the criteria above. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section.
|
G6016
|
PR DELIVERY COMP IMRT
|
HCPCS
|
Added the following statement: Intensity-modulated radiation therapy is not medically necessary for the treatment of thyroid cancers for all indications not meeting the criteria above. 12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section.
|
G6015
|
Radiation tx delivery imrt
|
HCPCS
|
12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section. 10/29/2015: Policy description updated regarding devices.
|
77386
|
HC IMRT COMPLEX
|
HCPCS
|
12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section. 10/29/2015: Policy description updated regarding devices.
|
77385
|
HC IMRT SIMPLE
|
HCPCS
|
12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section. 10/29/2015: Policy description updated regarding devices.
|
G6016
|
PR DELIVERY COMP IMRT
|
HCPCS
|
12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 77385 and 77386. Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section. 10/29/2015: Policy description updated regarding devices.
|
G6015
|
Radiation tx delivery imrt
|
HCPCS
|
Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section. 10/29/2015: Policy description updated regarding devices. Policy statements updated to change "radiation therapy" to "radiotherapy."
|
G6016
|
PR DELIVERY COMP IMRT
|
HCPCS
|
Added the following new 2015 HCPCS codes to the Code Reference section: G6015 and G6016. 08/25/2015: Medical policy revised to add ICD-10 codes. Added ICD-9 diagnosis code range 190.0 - 190.9 to the Code Reference section. 10/29/2015: Policy description updated regarding devices. Policy statements updated to change "radiation therapy" to "radiotherapy."
|
00216
|
ANESTH HEAD VESSEL SURGERY
|
CPT
|
For this procedure, we’d code 35471 for “transluminal balloon angioplasty, percutaneous; renal or other visceral artery,” and we’d add the modifier -66 for “surgical team.” So we’d end up with 35471-66. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Physical Status Modifier (For Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
These are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1.
|
00216
|
ANESTH HEAD VESSEL SURGERY
|
CPT
|
These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
These are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
- 2014 Level I and Level II CPT Modifiers
- CPT and HCPCS Level II Modifiers
- 2012 Coding Modifiers Table
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we've done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates.
|
00216
|
ANESTH HEAD VESSEL SURGERY
|
CPT
|
Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
- 2014 Level I and Level II CPT Modifiers
- CPT and HCPCS Level II Modifiers
- 2012 Coding Modifiers Table
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we've done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. In this webinar, you will learn about the 143 deleted codes and why they were given the boot.
|
00216
|
ANESTH HEAD VESSEL SURGERY
|
CPT
|
The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Source: http://www.medicalbillingandcoding.org/cpt-modifiers/
Complete List of CPT Modifiers 2015
To view a complete list of CPT Modifiers, you can check out these resources below:
- 2014 Level I and Level II CPT Modifiers
- CPT and HCPCS Level II Modifiers
- 2012 Coding Modifiers Table
As the year comes to an end and a new one is upon us, Certification Coaching Organization (CCO) has finally launched a video that explains exactly what is changing in CPT 2015. And we've done it in a “warm and fuzzy” fashion — The CCO Webinar on CPT Modifiers 2015 Updates. In this webinar, you will learn about the 143 deleted codes and why they were given the boot. You will also learn the 264 New codes and when to use them and if they replaced older codes and more.
|
99499
|
HC CONSULTATIVE PHYSICIAN, PRIMARY PHYSICIAN, PSYCHOLOGISTS, NP
|
HCPCS
|
In this
situation, you would add a/an
Level II code. When a neonate or infant is not considered critically ill but still needs intensive observation and other
intensive care services, the initial and continuing intensive care services codes are
99499, unlisted evaluation and management services. What CPT code is assigned to an ED service that has a detailed history and exam with a moderate level
What type of code includes all the words that describe the procedure the code represents? The _______ is the universal health insurance form for submission of outpatient services. J codes in the HCPCS Level II system are used to indicate
medications and dosages.
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY5/1998: Approved by Medical Policy Advisory Committee (MPAC)
4/12/2001: Managed Care Requirements deleted
5/2001: Reviewed by MPAC; investigational status remains
2/7/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
5/29/2002: Code Reference section completed
11/2002: Reviewed by MPAC; Scanning Laser Polarimetry (SLP) changed to medically necessary
7/2003: Reviewed by MPAC; "Description" section revised to be consistent with BCBSA, scanning laser ophthalmoscopy and optical coherence tomography are medically necessary for high risk individuals, scanning laser ophthalmoscopy, optical coherence tomography and scanning laser polarimetry are considered investigational as a method of monitoring disease progression in patients with glaucoma and as a screening test for glaucoma in the general population, measurement of pulsatile ocular blood flow or blood flow velocity with doppler ultrasonography is considered investigational in the diagnosis and follow-up of patients with glaucoma, FEP exception added
11/1/2004: Code Reference section updated, CPT code 92135 moved to covered, ICD-9 procedure code 88.90 added covered codes, ICD-9 diagnosis code 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 360.21, 362.85, V19.0 added covered codes, ICD-9 diagnosis 365.00, 365.01, 365.02, 365.03, 365.04, 365.10, 365.11, 365.12, 365.13, 365.14, 365.15, 365.20, 365.21, 365.22, 365.23, 365.24, 365.31, 365.32, 365.41, 365.42, 365.43, 365.44, 365.51, 365.52, 365.59, 365.60, 365.61, 365.62, 365.63, 365.64, 365.65, 365.81, 365.82, 365.83, 365.89, 365.9 description revised and moved from non-covered to covered, CPT code 93875 added to non-covered codes
1/10/2005: Code Reference section updated, ICD-9 diagnosis code 362.01, 362.02, 368.40, 368.41, 368.42, 368.43, 368.44, 368.45, 368.46, 368.47 added covered codes, HCPCS S0820 deleted
11/16/2005: Code Reference section updated, ICD9 diagnosis codes 362.03 - 362.07 added
3/17/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/18/2008: Policy reviewed, no changes
9/16/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code reference section updated per 2009 CPT/HCPCS revisions
08/03/2010: Policy Description revised to remove optic nerve head analyzers. Policy statement revised to remove optic nerve head analyzers and analysis of the optic nerve (retinal nerve fiber layer) in the diagnosis and evaluation of patients with glaucoma or glaucoma suspects may be considered medically necessary when using scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography. FEP verbiage revised in Policy Exceptions section.
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY5/1998: Approved by Medical Policy Advisory Committee (MPAC)
4/12/2001: Managed Care Requirements deleted
5/2001: Reviewed by MPAC; investigational status remains
2/7/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
5/29/2002: Code Reference section completed
11/2002: Reviewed by MPAC; Scanning Laser Polarimetry (SLP) changed to medically necessary
7/2003: Reviewed by MPAC; "Description" section revised to be consistent with BCBSA, scanning laser ophthalmoscopy and optical coherence tomography are medically necessary for high risk individuals, scanning laser ophthalmoscopy, optical coherence tomography and scanning laser polarimetry are considered investigational as a method of monitoring disease progression in patients with glaucoma and as a screening test for glaucoma in the general population, measurement of pulsatile ocular blood flow or blood flow velocity with doppler ultrasonography is considered investigational in the diagnosis and follow-up of patients with glaucoma, FEP exception added
11/1/2004: Code Reference section updated, CPT code 92135 moved to covered, ICD-9 procedure code 88.90 added covered codes, ICD-9 diagnosis code 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 360.21, 362.85, V19.0 added covered codes, ICD-9 diagnosis 365.00, 365.01, 365.02, 365.03, 365.04, 365.10, 365.11, 365.12, 365.13, 365.14, 365.15, 365.20, 365.21, 365.22, 365.23, 365.24, 365.31, 365.32, 365.41, 365.42, 365.43, 365.44, 365.51, 365.52, 365.59, 365.60, 365.61, 365.62, 365.63, 365.64, 365.65, 365.81, 365.82, 365.83, 365.89, 365.9 description revised and moved from non-covered to covered, CPT code 93875 added to non-covered codes
1/10/2005: Code Reference section updated, ICD-9 diagnosis code 362.01, 362.02, 368.40, 368.41, 368.42, 368.43, 368.44, 368.45, 368.46, 368.47 added covered codes, HCPCS S0820 deleted
11/16/2005: Code Reference section updated, ICD9 diagnosis codes 362.03 - 362.07 added
3/17/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/18/2008: Policy reviewed, no changes
9/16/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code reference section updated per 2009 CPT/HCPCS revisions
08/03/2010: Policy Description revised to remove optic nerve head analyzers. Policy statement revised to remove optic nerve head analyzers and analysis of the optic nerve (retinal nerve fiber layer) in the diagnosis and evaluation of patients with glaucoma or glaucoma suspects may be considered medically necessary when using scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography. FEP verbiage revised in Policy Exceptions section.
|
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 medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. POLICY HISTORY5/1998: Approved by Medical Policy Advisory Committee (MPAC)
4/12/2001: Managed Care Requirements deleted
5/2001: Reviewed by MPAC; investigational status remains
2/7/2002: Investigational definition added
5/2/2002: Type of Service and Place of Service deleted
5/29/2002: Code Reference section completed
11/2002: Reviewed by MPAC; Scanning Laser Polarimetry (SLP) changed to medically necessary
7/2003: Reviewed by MPAC; "Description" section revised to be consistent with BCBSA, scanning laser ophthalmoscopy and optical coherence tomography are medically necessary for high risk individuals, scanning laser ophthalmoscopy, optical coherence tomography and scanning laser polarimetry are considered investigational as a method of monitoring disease progression in patients with glaucoma and as a screening test for glaucoma in the general population, measurement of pulsatile ocular blood flow or blood flow velocity with doppler ultrasonography is considered investigational in the diagnosis and follow-up of patients with glaucoma, FEP exception added
11/1/2004: Code Reference section updated, CPT code 92135 moved to covered, ICD-9 procedure code 88.90 added covered codes, ICD-9 diagnosis code 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 360.21, 362.85, V19.0 added covered codes, ICD-9 diagnosis 365.00, 365.01, 365.02, 365.03, 365.04, 365.10, 365.11, 365.12, 365.13, 365.14, 365.15, 365.20, 365.21, 365.22, 365.23, 365.24, 365.31, 365.32, 365.41, 365.42, 365.43, 365.44, 365.51, 365.52, 365.59, 365.60, 365.61, 365.62, 365.63, 365.64, 365.65, 365.81, 365.82, 365.83, 365.89, 365.9 description revised and moved from non-covered to covered, CPT code 93875 added to non-covered codes
1/10/2005: Code Reference section updated, ICD-9 diagnosis code 362.01, 362.02, 368.40, 368.41, 368.42, 368.43, 368.44, 368.45, 368.46, 368.47 added covered codes, HCPCS S0820 deleted
11/16/2005: Code Reference section updated, ICD9 diagnosis codes 362.03 - 362.07 added
3/17/2006: Policy reviewed, no changes
12/19/2007: Coding updated per 2008 CPT/HCPCS revisions
1/18/2008: Policy reviewed, no changes
9/16/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code reference section updated per 2009 CPT/HCPCS revisions
08/03/2010: Policy Description revised to remove optic nerve head analyzers. Policy statement revised to remove optic nerve head analyzers and analysis of the optic nerve (retinal nerve fiber layer) in the diagnosis and evaluation of patients with glaucoma or glaucoma suspects may be considered medically necessary when using scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography. FEP verbiage revised in Policy Exceptions section.
|
G0103
|
PSA SCREENING
|
HCPCS
|
Men with one or more risk factors should consult a doctor about whether to begin screenings earlier. When having a screening discussion, decision aids and provisions should be documented in the medical record, particularly when the patient decides against screening. Codes for reporting prostate cancer screening using HCPCS Level II codes are:
G0102 Prostate cancer screening; digital rectal exam
G0103 Prostate cancer screening; prostate specific antigen test (PSA)
The ICD-10 diagnosis code to support either screening is:
Z12.5 Encounter for screening for malignant neoplasm of prostate
According to the Medicare Intermediary Manual, Transmittal 1801, Change Request (CR) 1098, both screening digital rectal examinations and PSA tests are covered once every 12 months for men beginning at age 50 (at least 11 months must have passed since the last Medicare-covered screening was performed). Although screening may help detect prostate cancer early, only a biopsy can diagnose prostate cancer, for sure. Treatment Options Are Based on Stages
There are plenty of treatment options for prostate cancer.
|
G0102
|
PR PROSTATE CA SCREENING; DRE
|
HCPCS
|
Men with one or more risk factors should consult a doctor about whether to begin screenings earlier. When having a screening discussion, decision aids and provisions should be documented in the medical record, particularly when the patient decides against screening. Codes for reporting prostate cancer screening using HCPCS Level II codes are:
G0102 Prostate cancer screening; digital rectal exam
G0103 Prostate cancer screening; prostate specific antigen test (PSA)
The ICD-10 diagnosis code to support either screening is:
Z12.5 Encounter for screening for malignant neoplasm of prostate
According to the Medicare Intermediary Manual, Transmittal 1801, Change Request (CR) 1098, both screening digital rectal examinations and PSA tests are covered once every 12 months for men beginning at age 50 (at least 11 months must have passed since the last Medicare-covered screening was performed). Although screening may help detect prostate cancer early, only a biopsy can diagnose prostate cancer, for sure. Treatment Options Are Based on Stages
There are plenty of treatment options for prostate cancer.
|
9071
|
Capsaicin 8% patch
|
APC
|
- Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.
|
9201
|
Rabies ig ht&sol human im
|
APC
|
- Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.
|
9214
|
Bevacizumab injection
|
APC
|
- Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.
|
9065
|
Argatroban esrd dialysis
|
APC
|
- Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.
|
9071
|
Capsaicin 8% patch
|
APC
|
The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.
|
9201
|
Rabies ig ht&sol human im
|
APC
|
The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.
|
9214
|
Bevacizumab injection
|
APC
|
The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.
|
9065
|
Argatroban esrd dialysis
|
APC
|
The codes were created for data collection and assessment of new services and procedures. Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.
|
9071
|
Capsaicin 8% patch
|
APC
|
Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike.
|
9201
|
Rabies ig ht&sol human im
|
APC
|
Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike.
|
9214
|
Bevacizumab injection
|
APC
|
Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike.
|
9065
|
Argatroban esrd dialysis
|
APC
|
Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike.
|
9071
|
Capsaicin 8% patch
|
APC
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
9065
|
Argatroban esrd dialysis
|
APC
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
90716
|
VARIVAX PVT
|
HCPCS
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
90658
|
Iiv3 vaccine splt 0.5 ml im
|
HCPCS
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
9214
|
Bevacizumab injection
|
APC
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
99214
|
Telehealth Visit EXT
|
HCPCS
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
9201
|
Rabies ig ht&sol human im
|
APC
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
12002
|
S/LCA SCLP/NK EXTR 2.7-7.5CM
|
HCPCS
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
99397
|
PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER
|
HCPCS
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
99201
|
Office Visit New Min
|
HCPCS
|
Source: https://www.aapc.com/resources/medical-coding/cpt.aspx
What Are Examples of CPT codes
- 99201 a physical exam
- 90658 flu vaccination
- 90716 chicken pox vaccine (varicella)
- 12002 laceration repair
- 99214 may be used for an office visit
- 99397 may be used for a preventive exam if you are over 65
To complete list of CPT codes, AAPC provided a link http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber. CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year. If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually. Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:
- CPT 2016 Professional Edition
- 2016 ICD-10-CM Codebook
- ICD-10-CM 2016 Code Set
- HCPCS 2016 Level II Professional Edition
- CPT Changes 2016: An Insider's View
Related CPT Coding Posts:
- How to Look Up CPT Codes for FREE — 7 Steps!
|
1745
|
Thoracoscopic robotic assisted procedure
|
ICD
|
PMID 17141745. - World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation.
|
1743
|
Percutaneous robotic assisted procedure
|
ICD
|
The Journal of Sexual Medicine. 8 (3): 751–757. doi:10.1111/j.1743-6109.2011.02567.x. - ^"Gender identity disorder in adolescence and adulthood". ICD10Data.com.
|
1745
|
Thoracoscopic robotic assisted procedure
|
ICD
|
PMID 17141745. doi:10.1016/j.biopsych.2006.08.041. - World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation.
|
G8978
|
G8978CK
|
HCPCS
|
After that, WebPT will store your MIPS data—and send it off to CMS at the end of the reporting year. For the Improvement Activities category, we’ll provide you with a link to the Improvement Activities attestation page where you can document your performance. More MIPS Resources
What was in the 2019 Final Rule? In November 2018, Medicare released its final rule, at which point we learned the following:
FLR is no more. Beginning in 2019, rehab therapists no longer need to complete functional limitation reporting (FLR) in order to receive reimbursement, which means HCPCS codes G8978 through G8999 and G9158 through G9186—as well as severity modifiers CH through CN—are no longer necessary, although providers may continue to use them for another year.
|
G8978
|
G8978CK
|
HCPCS
|
More MIPS Resources
What was in the 2019 Final Rule? In November 2018, Medicare released its final rule, at which point we learned the following:
FLR is no more. Beginning in 2019, rehab therapists no longer need to complete functional limitation reporting (FLR) in order to receive reimbursement, which means HCPCS codes G8978 through G8999 and G9158 through G9186—as well as severity modifiers CH through CN—are no longer necessary, although providers may continue to use them for another year. There’s still a therapy soft cap—with a slightly higher threshold amount. In 2018, the therapy cap was repealed and replaced with a soft cap, which means that the threat of a hard cap without an exceptions process is no more.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
- Lower respiratory infection: If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, this should be assigned with code J22, Unspecified acute lower respiratory infection, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere. - Suspected exposure with persons confirmed to have COVID-19: Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. - Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001).
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
- Suspected exposure with persons confirmed to have COVID-19: Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. - Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
- Suspected exposure with persons confirmed to have COVID-19: Assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. - Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
- Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets).
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
- Concern about possible exposure that is ruled out after evaluation: Assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. - Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets).
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
- Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
- Testing: There are two new HCPCS codes for healthcare providers who need to test patients for coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828).
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828).
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828). It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020.
|
U0002
|
HC Sars-Cov-2 Naa Coronavirus
|
HCPCS
|
HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828). It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020. CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after Feb. 4, 2020. The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828). It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020. CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. CMS has indicated that the Medicare claims processing system will be able to accept HCPCS code U0001 on April 1, 2020 for dates of service on or after February 4, 2020.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
The CDC’s coding guidance states that coders should not assign code B97.29 when the provider documents “suspected”, “possible” or “probable” COVID-19, but rather assign a code for the reason for the encounter (such as cough, fever, or Z20.828). It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020. CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. CMS has indicated that the Medicare claims processing system will be able to accept HCPCS code U0001 on April 1, 2020 for dates of service on or after February 4, 2020. LBMC is monitoring the latest news from the Center for Medicare and Medicaid Services (CMS), the Centers for Disease Control (CDC), the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) in addition to the American Hospital Association (AHA) Coding Clinic for any official coding advice relating to the novel coronavirus.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
It should be noted that the WHO has emergently implemented a new ICD-10-CM code, U07.1 2019-nCoV acute respiratory disease, that will be effective with the next update on Oct. 1, 2020. CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. CMS has indicated that the Medicare claims processing system will be able to accept HCPCS code U0001 on April 1, 2020 for dates of service on or after February 4, 2020. LBMC is monitoring the latest news from the Center for Medicare and Medicaid Services (CMS), the Centers for Disease Control (CDC), the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) in addition to the American Hospital Association (AHA) Coding Clinic for any official coding advice relating to the novel coronavirus. Jenny Harvey is a manager in the Healthcare Consulting division of LBMC.
|
U0001
|
HC NOVEL CORONAVIRUS REALT TIME PCR
|
HCPCS
|
CMS has developed a new Healthcare Common Procedure Coding System (HCPCS) code for providers and laboratories who test for COVID-19 using the 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel. CMS has indicated that the Medicare claims processing system will be able to accept HCPCS code U0001 on April 1, 2020 for dates of service on or after February 4, 2020. LBMC is monitoring the latest news from the Center for Medicare and Medicaid Services (CMS), the Centers for Disease Control (CDC), the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) in addition to the American Hospital Association (AHA) Coding Clinic for any official coding advice relating to the novel coronavirus. Jenny Harvey is a manager in the Healthcare Consulting division of LBMC. She holds numerous certification and is an AHIMA-approved ICD-10-CM/PCS trainer.
|
0100T
|
Prosth retina receive&gen
|
HCPCS
|
The authors noted that improved mobility and object detection are some of the more notable findings from the clinical trials. However, significant vision restoration will require both better technology and improved understanding of the interaction between electrical stimulation and the retina. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|0100T||Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy|
|ICD-10 codes not covered for indications listed in the CPB:|
|E08.311 - E08.39||Diabetes mellitus due to underlying condition with ophthalmic complications [retinopathy]|
|E09.311 - E09.39||Drug or chemical induaced diabetes mellitus with ophthalmic complications [retinopathy]|
|E10.311 - E10.39||Type 1 diabetes mellitus with ophthalmic complications [retinopathy]|
|E11.311 - E11.39||Type 2 diabetes mellitus with ophthalmic complications [retinopathy]|
|E13.311 - E13.39||Other specified diabetes mellitus with ophthalmic complications [retinopathy]|
|H31.101 - H31.129||Choroidal degeneration|
|H33.001 - H35.9||Retinal detachments and breaks, retinal vascular occlusions and other retinal disorders|
|
0100T
|
Prosth retina receive&gen
|
HCPCS
|
However, significant vision restoration will require both better technology and improved understanding of the interaction between electrical stimulation and the retina. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|0100T||Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy|
|ICD-10 codes not covered for indications listed in the CPB:|
|E08.311 - E08.39||Diabetes mellitus due to underlying condition with ophthalmic complications [retinopathy]|
|E09.311 - E09.39||Drug or chemical induaced diabetes mellitus with ophthalmic complications [retinopathy]|
|E10.311 - E10.39||Type 1 diabetes mellitus with ophthalmic complications [retinopathy]|
|E11.311 - E11.39||Type 2 diabetes mellitus with ophthalmic complications [retinopathy]|
|E13.311 - E13.39||Other specified diabetes mellitus with ophthalmic complications [retinopathy]|
|H31.101 - H31.129||Choroidal degeneration|
|H33.001 - H35.9||Retinal detachments and breaks, retinal vascular occlusions and other retinal disorders|
|
90621
|
MEN B TRUMEMBA PVT
|
HCPCS
|
The preferred age for MenB vaccination is 16 through 18 years of age." The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90733
|
HC MENINGOCOCOCCAL POLYS VAC-SUBQ
|
HCPCS
|
The preferred age for MenB vaccination is 16 through 18 years of age." The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90644
|
Hib-mency vacc 6wk-18m0 im
|
HCPCS
|
The preferred age for MenB vaccination is 16 through 18 years of age." The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90620
|
HC MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM
|
HCPCS
|
The preferred age for MenB vaccination is 16 through 18 years of age." The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90734
|
Meningococcal vaccine, serogroups A, C, W, Y, diphtheria toxoid carrier vaccine
|
HCPCS
|
The preferred age for MenB vaccination is 16 through 18 years of age." The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90471
|
VACCINE ADMIN
|
HCPCS
|
The preferred age for MenB vaccination is 16 through 18 years of age." The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90621
|
MEN B TRUMEMBA PVT
|
HCPCS
|
The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90733
|
HC MENINGOCOCOCCAL POLYS VAC-SUBQ
|
HCPCS
|
The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90644
|
Hib-mency vacc 6wk-18m0 im
|
HCPCS
|
The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90620
|
HC MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM
|
HCPCS
|
The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90734
|
Meningococcal vaccine, serogroups A, C, W, Y, diphtheria toxoid carrier vaccine
|
HCPCS
|
The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
90471
|
VACCINE ADMIN
|
HCPCS
|
The recommendation is labeled as "Category B," meaning that individual clinical decision-making is recommended. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015 :|
|CPT codes covered if selection criteria are met:|
|Meningococcal group B vaccine (Trumenba or Bexsero) [for individuals 10 years of age or older]:|
|90620||Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular use|
|90621||Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCT-TT), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|Other CPT codes related to the CPB:|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vacctine/toxoid)|
|ICD-10 codes covered if selection criteria are met:|
|B20||Human immunodeficiency virus [HIV] disease|
|D57.00 - D57.819||Sickle-cell disorders|
|D84.1||Defects in the complement system|
|D89.89||Other specified disorders involving the immune mechanism, not elsewhere classified|
|Z02.1||Encounter for pre-employment examination|
|Z02.3||Encounter for examination for recruitment to armed forces|
|Z02.89||Encounter for other administrative examinations|
|Z20.89||Contact with and (suspected) exposure to other communicable diseases|
|Z20.811||Contact with and (suspected) exposure to meningococcus|
|Z21||Asymptomatic human immunodeficiency virus [HIV] infection status|
|Z23||Encounter for immunization|
|Z59.3||Problems related to living in residential institution|
|Z65.8||Other specified problems related to psychosocial circumstances [military deployment status]|
|Z79.81||Acquired absence of spleen|
|Z90.81||Acquired absence of spleen|
|Z94.0||Kidney transplant status|
|Z94.1||Heart transplant status|
|Z94.2||Lung transplant status|
|Z94.3||Heart and lungs transplant status|
|Z94.4||Liver transplant status|
|Z94.82||Intestine transplant status|
|Z94.83||Pancreas transplant status|
|
17000
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
11313
|
Shave skin lesion >2.0 cm
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
11201
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA_ EACH ADDITIONAL 10 LESIONS, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
11400
|
Removal of noncancer skin growth of body, arms, or legs, 0.5 cm or less
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
17004
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
56515
|
PR DESTRUCTION LESIONS VULVA EXTENSIVE
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
11200
|
Shave-Benign, Skin Tags1-15-FAC
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
17110
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
56501
|
PR DESTRUCTION LESIONS VULVA SIMPLE
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
54065
|
PR DSTRJ LESION PENIS EXTENSIVE
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
57061
|
PR DESTRUCTION VAGINAL LESIONS SIMPLE
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
11446
|
Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, more than 4.0 cm
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
54050
|
PR DSTRJ LESION PENIS SIMPLE CHEMICAL
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
17111
|
PR DESTRUCTION BENIGN LESIONS 15/>
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
11300
|
Shaving of skin growth of body, arms, or legs, 0.5 cm or less
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
57065
|
PR DESTRUCTION VAGINAL LESIONS EXTENSIVE
|
HCPCS
|
Although nonexcisional destructive methods (.g., laser, cryotherapy) has been used to remove isolated porokeratosis lesions, there are no studies showing the value of prophylactic non-excisional surgical treatment in reducing the incidence of malignancy in cases of porokeratosis (Sertznig, et al., 2012). If the decision is made to excise or destroy a lesion for prophylactic purposes, doing so in an urgent manner is not necessary, as the period between lesion development and malignancy often spans decades. After removal, clinical follow-up still should be performed yearly to evaluate these patients for the development of new or recurrent lesions (Spencer, 2011; Spencer, 2012). |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|CPT codes covered if selection criteria are met:|
|11200 - 11201||Removal of skin tags, multiple fibrocutaneous tags, any area|
|11300 - 11313||Shaving of epidermal or dermal lesions|
|11400 - 11446||Excision, benign lesions|
|17000 - 17004||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses)|
|17110 - 17111||Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions|
|54050 - 54065||Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle)|
|56501 - 56515||Destruction of lesion(s), vulva|
|57061 - 57065||Destruction of vaginal lesion(s)|
|ICD-10 codes covered if selection criteria are met:|
|A63.0||Anogenital (venereal) warts|
|B07.0 - B07.9||Viral warts [* note - report 17110-17111 per AMA CPT guidelines]|
|D04.0 - D04.9||Carcinoma in situ of skin [Bowen's disease, lentigo maligna]|
|D17.0 - D17.39||Benign lipomatous neoplasm of skin and subcutaneous tissue|
|D22.0 - D22.9||Melanocytic nevi|
|D23.0 - D23.9||Other benign neoplasm of skin|
|K13.21||Leukoplakia of oral mucosa, including tongue|
|L82.0 - L82.1||Seborrheic keratosis|
|
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