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92520
|
PR LARYNGEAL FUNCTION STUDIES
|
HCPCS
|
But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507.
|
92511
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
HCPCS
|
But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507.
|
31579
|
PR LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY
|
HCPCS
|
But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507.
|
92524
|
ST SPEECH BEHAVIORAL QUALI OF
|
HCPCS
|
But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507.
|
92597
|
PR EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC
|
HCPCS
|
But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507.
|
92507
|
Treatment of speech, language, voice, communication, and/or hearing processing disorder
|
HCPCS
|
But for more information on any of the coding systems that I'm reviewing in this course, there is a reference that is available for free on the ASHA website where all these things are listed and explained: www.asha.org/practice/reimbursement/coding/hcpcs_slp/. HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507.
|
92520
|
PR LARYNGEAL FUNCTION STUDIES
|
HCPCS
|
HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507. I will be talking about these other codes more in-depth as I go through presentation.
|
92511
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
HCPCS
|
HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507. I will be talking about these other codes more in-depth as I go through presentation.
|
31579
|
PR LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY
|
HCPCS
|
HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507. I will be talking about these other codes more in-depth as I go through presentation.
|
92524
|
ST SPEECH BEHAVIORAL QUALI OF
|
HCPCS
|
HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507. I will be talking about these other codes more in-depth as I go through presentation.
|
92597
|
PR EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC
|
HCPCS
|
HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507. I will be talking about these other codes more in-depth as I go through presentation.
|
92507
|
Treatment of speech, language, voice, communication, and/or hearing processing disorder
|
HCPCS
|
HCPCS Level I - Voice and Resonance CPT Codes for SLPs
I'm going to spend the rest of the time discussing HCPCS Level I, rather than Level II. I'm not going to read each of these to you, but for those of us who practice in voice and resonance, these are the most common CPT codes that we use in our daily practice. - CPT 31579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
- CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
- CPT 92511 Nasopharyngoscopy with endoscope (separate procedure)
- CPT 92520 Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)
- CPT 92524 Behavioral and qualitative analysis of voice and resonance
- CPT 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech
For example, CPT 31579 is for laryngoscopy, flexible or rigid scope, with stroboscopy. Next, treatment of speech, language, voice communication and/or auditory processing disorder for one individual is CPT 92507. I will be talking about these other codes more in-depth as I go through presentation.
|
92508
|
Speech/hearing therapy
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92524
|
ST SPEECH BEHAVIORAL QUALI OF
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92522
|
ST SPEECH EVAL OF SOUND PRODUC
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
T1023
|
PR PROGRAM INTAKE ASSESSMENT
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
T1027
|
HC Family Support Individ 15min
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92523
|
ST SPEECH EVAL SOUND W LANGUAG COMPREHEN
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92610
|
ST SWALLOWING EVALUATION
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
S9152
|
Speech therapy, re-eval
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
S9128
|
Speech therapy, in the home,
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
H2014
|
Skills train and dev, 15 min
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
T1028
|
Home environment assessment
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92507
|
Treatment of speech, language, voice, communication, and/or hearing processing disorder
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92521
|
ST SPEECH EVAL OF FLUENCY
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92526
|
TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
G0153
|
HHCP-svs of s/l path,ea 15mn
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
T2024
|
Serv asmnt/care plan waiver
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
E2120
|
Pulse gen sys tx endolymp fl
|
HCPCS
|
Patients then place an ear-cuff in the external ear canal and treat themselves for 3 minutes, 3 times daily. Treatment is continued for as long as patients find themselves in a period of attacks of vertigo. In 1999, the Meniett® device (Medtronic, Minneapolis, MN) received clearance to market through a U.S. Food and Drug Administration (FDA) 510(k) process specifically as a symptomatic treatment of Meniere's disease. Transtympanic micropressure applications as a treatment of Meniere`s disease are considered investigational. HCPCS code E2120, pulse generator system for tympanic treatment of inner ear endolymphatic fluid, describes the Meniett device.
|
E2120
|
Pulse gen sys tx endolymp fl
|
HCPCS
|
In 1999, the Meniett® device (Medtronic, Minneapolis, MN) received clearance to market through a U.S. Food and Drug Administration (FDA) 510(k) process specifically as a symptomatic treatment of Meniere's disease. Transtympanic micropressure applications as a treatment of Meniere`s disease are considered investigational. HCPCS code E2120, pulse generator system for tympanic treatment of inner ear endolymphatic fluid, describes the Meniett device. Use of the Meniett device requires a prior tympanostomy procedure, a novel indication for this common procedure. Plans with specific medical necessity criteria for tympanostomy may thus be able to prospectively identify claims for the Meniett device.
|
A4638
|
Repl batt pulse gen sys
|
HCPCS
|
2012. Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study.
|
E2120
|
Pulse gen sys tx endolymp fl
|
HCPCS
|
2012. Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study.
|
A4638
|
Repl batt pulse gen sys
|
HCPCS
|
Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged|
|
E2120
|
Pulse gen sys tx endolymp fl
|
HCPCS
|
Available online at: http://guidance.nice.org.uk/IPG426/Guidance/pdf/English. Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged|
|
A4638
|
Repl batt pulse gen sys
|
HCPCS
|
Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged|
|
E2120
|
Pulse gen sys tx endolymp fl
|
HCPCS
|
Last accessed July 2014. |ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged|
|
A4638
|
Repl batt pulse gen sys
|
HCPCS
|
|ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged|
|
E2120
|
Pulse gen sys tx endolymp fl
|
HCPCS
|
|ICD-9 Diagnosis||Investigational for all diagnoses|
|386.00 – 386.04||Meniere`s disease code range|
|HCPCS||A4638||Replacement battery for patient-owned ear generator, each|
|E2120||Pulse generator system for tympanic treatment of inner ear endolymphatic fluid|
|ICD-10-CM (effective 10/1/15)||Investigational for all diagnoses|
|H81.01-H81.09||Meniere`s disease code range|
|ICD-10-PCS (effective 10/1/15)||ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.|
Meniere`s Disease, Meniett Device
Meniett Device, Meniere`s Disease
|04/29/03||Add policy to Durable Medical Equipment section||New policy|
|12/17/03||Replace policy||;">New HCPCS codes added only; no other review|
|04/16/04||Replace policy||Policy updated with literature review; no new literature, no change in policy statement|
|11/9/04||Replace policy||Policy updated with literature and review of randomized study. Reference added; no change in policy statement|
|08/17/05||Replace policy||Policy updated with literature search; no changes in policy statement|
|04/17/07||Replace policy||Policy updated with literature search; reference numbers 6 and 7 added; no change in policy statement|
|09/11/08||Replace policy||Policy updated with literature search; references 8-11 added; no change in policy statement|
|10/06/09||Replace policy||Policy updated with literature search through July 2009; reference 11 added; policy statement unchanged|
|10/08/10||Replace policy||Policy updated with literature search through July 2010; policy statement unchanged|
|10/04/11||Replace policy||Policy updated with literature search through July 2011; policy statement unchanged|
|10/11/12||Replace policy||Policy updated with literature search through August 2012; references 12 and 14 added; policy statement unchanged|
|10/10/13||Replace policy||Policy updated with literature search through August 26, 2013; policy statement unchanged|
|10/09/14||Replace policy||Policy updated with literature review through August 28, 2014; policy statement unchanged|
|
S9345
|
HIT anti-hemophil diem
|
HCPCS
|
BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed.
|
36440
|
PR PUSH TRANSFUSION BLOOD 2 YR OR YOUNGER
|
HCPCS
|
BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed.
|
85244
|
HC CLOTTING; FACTOR VIII (AHG) RELATED ANTIGEN
|
HCPCS
|
BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed.
|
S9345
|
HIT anti-hemophil diem
|
HCPCS
|
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed. BCBSMS information added.
|
36440
|
PR PUSH TRANSFUSION BLOOD 2 YR OR YOUNGER
|
HCPCS
|
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed. BCBSMS information added.
|
85244
|
HC CLOTTING; FACTOR VIII (AHG) RELATED ANTIGEN
|
HCPCS
|
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed. BCBSMS information added.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary. 4/1999: Approved by Pharmacy & Therapeutics (P & T) Oncology Committee
1/30/2002: Factor VIII (Human), Factor VIII (Recombinant) and Factor VIII (Porcine) policies combined into one policy titled "Factor VIII"; Prior authorization deleted
4/24/2002: Type of Service and Place of Service deleted. Code Reference section completed
11/6/2002: Koate-DVI® added, Koate-P® and Koate-HP® deleted
8/17/2004: Code Reference section updated, ICD-9 diagnosis code 286.1, 286.4, 286.5 added, HCPCS S9345 added
9/24/2004: Code Reference section updated, CPT code 36440, 85244 deleted
10/29/2006: Factor VIII and Factor IX policies combined
9/12/2007: Added Mississippi Comprehensive Health Insurance Risk Pool Association will no longer provide benefits for antihemophilic factor, factor VIII, factor IX, factor concentrate or factorate products of any kind and services or related supplies received on an outpatient basis effective August 1, 2007, to Policy Exceptions
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions. 01/01/2009: Accredo preferred provider information removed. BCBSMS information added.
|
Q2023
|
Xyntha - inj
|
CPT
|
01/01/2009: Accredo preferred provider information removed. BCBSMS information added. 6/30/2009: New HCPC code Q2023 added to covered table. 8/26/2009: Policy statement updated to include medically necessary indications for VIII for routine prophylaxis to reduce the frequency of bleeding episodes and the risk of joint damage in children (0-16) with hemophilia A with no pre-existing joint damage. 12/15/2009: Coding Section revised for 2010 CPT4 and HCPCS revisions
03/08/2010: Description section was updated with Humate-P®, Wilate®.
|
Q2023
|
Xyntha - inj
|
CPT
|
BCBSMS information added. 6/30/2009: New HCPC code Q2023 added to covered table. 8/26/2009: Policy statement updated to include medically necessary indications for VIII for routine prophylaxis to reduce the frequency of bleeding episodes and the risk of joint damage in children (0-16) with hemophilia A with no pre-existing joint damage. 12/15/2009: Coding Section revised for 2010 CPT4 and HCPCS revisions
03/08/2010: Description section was updated with Humate-P®, Wilate®. Also added brand names (ReFacto®, Xyntha® and Advate®) for Factor VIII (recombinant).
|
Q2023
|
Xyntha - inj
|
CPT
|
6/30/2009: New HCPC code Q2023 added to covered table. 8/26/2009: Policy statement updated to include medically necessary indications for VIII for routine prophylaxis to reduce the frequency of bleeding episodes and the risk of joint damage in children (0-16) with hemophilia A with no pre-existing joint damage. 12/15/2009: Coding Section revised for 2010 CPT4 and HCPCS revisions
03/08/2010: Description section was updated with Humate-P®, Wilate®. Also added brand names (ReFacto®, Xyntha® and Advate®) for Factor VIII (recombinant). Policy Section updated with coverage for Von Willebrand disease for Factor VIII.
|
J7185
|
Xyntha inj
|
HCPCS
|
Policy Section updated with coverage for Von Willebrand disease for Factor VIII. Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX."
|
J7187
|
Injection, von willebrand factor complex (humate-p), per iu vwf:rco
|
HCPCS
|
Policy Section updated with coverage for Von Willebrand disease for Factor VIII. Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX."
|
J7184
|
Wilate injection
|
HCPCS
|
Policy Section updated with coverage for Von Willebrand disease for Factor VIII. Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX."
|
J7185
|
Xyntha inj
|
HCPCS
|
Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated.
|
J7187
|
Injection, von willebrand factor complex (humate-p), per iu vwf:rco
|
HCPCS
|
Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated.
|
J7184
|
Wilate injection
|
HCPCS
|
Policy Exceptions Section updated to remove Risk Pool language. HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated.
|
J7185
|
Xyntha inj
|
HCPCS
|
HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements.
|
J7187
|
Injection, von willebrand factor complex (humate-p), per iu vwf:rco
|
HCPCS
|
HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements.
|
J7184
|
Wilate injection
|
HCPCS
|
HCPCS code J7185 & J7187 were added to Covered Codes for Factor VIII. 02/28/2011: Added new HCPCS code J7184 for Wilate® to the Code Reference section. 04/01/2014: Policy title changed from "Hemophilia Factor VIII (Human, Recombinant, Porcine) and Factor IX (Human, Complex, Recombinant)" to "Hemophilia Factor VIII Factor IX." Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements.
|
J7182
|
Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu
|
HCPCS
|
Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201.
|
J7200
|
Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
|
HCPCS
|
Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201.
|
J7201
|
Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
|
HCPCS
|
Policy description and FDA Approved Indications for Factors VIII and IX were updated. Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201.
|
J7195
|
Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
|
HCPCS
|
Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195.
|
J7182
|
Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu
|
HCPCS
|
Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195.
|
J7200
|
Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
|
HCPCS
|
Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195.
|
J7201
|
Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
|
HCPCS
|
Policy statement updated to include "Factor VIII Deficiency" and "Hemophilia B" in medically necessary statements. Removed deleted HCPCS code Q2023 from the Code Reference section. 12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195.
|
J7195
|
Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
|
HCPCS
|
12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10.
|
J7182
|
Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu
|
HCPCS
|
12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10.
|
J7200
|
Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
|
HCPCS
|
12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10.
|
J7201
|
Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
|
HCPCS
|
12/31/2014: Added the following new 2015 HCPCS code for Factor VIII to the Code Reference section: J7182. Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10.
|
J7195
|
Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
|
HCPCS
|
Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59.
|
J7200
|
Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
|
HCPCS
|
Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59.
|
J7201
|
Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
|
HCPCS
|
Added the following new 2015 HCPCS codes for Factor IX to the Code Reference section: J7200 and J7201. Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59.
|
J7184
|
Wilate injection
|
HCPCS
|
Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184.
|
J7195
|
Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified
|
HCPCS
|
Revised the description of the following HCPCS code: J7195. 05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184.
|
J7184
|
Wilate injection
|
HCPCS
|
05/28/2015: Policy description updated to add the brand name Eloctate® for Factor VIII (recombinant) and Alprolix® for Factor IX (recombinant). 08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184. 03/01/2016: Policy description updated to add the brand name Nuwiq® for Factor VIII (recombinant) and brand names Rixibus® and Ixinity® for Factor IX (recombinant).
|
J7184
|
Wilate injection
|
HCPCS
|
08/28/2015: Code Reference section updated for ICD-10. Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184. 03/01/2016: Policy description updated to add the brand name Nuwiq® for Factor VIII (recombinant) and brand names Rixibus® and Ixinity® for Factor IX (recombinant). Policy statement unchanged.
|
J7184
|
Wilate injection
|
HCPCS
|
Extended ICD-9 diagnosis code 286.5 to the fifth digit as 286.52 - 286.59. Removed deleted HCPCS code J7184. 03/01/2016: Policy description updated to add the brand name Nuwiq® for Factor VIII (recombinant) and brand names Rixibus® and Ixinity® for Factor IX (recombinant). Policy statement unchanged. Policy guidelines updated to add medically necessary definition.
|
C1715
|
SET BRACHYTHERAPY 20CM BEVEL 18GA 2 PART HUB DESIGN STABILIZATION
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77326
|
Brachytx isodose calc simp
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
C2639
|
SEED BRACHYTHERAPY IODINE-125 NEEDLE LOOSE TRAY STERILE
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77762
|
HC INTRACAVITARY RADIATION SOURCE APPLIC INTERMED
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
76965
|
Echo guidance radiotherapy
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
Q3001
|
Radioelements for brachytherapy, any type, each
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77327
|
Brachytx isodose calc interm
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
C2640
|
HC Palladium-103 Stranded
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77799
|
HC UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77778
|
HC ASRG INTERSTIT RADIOELEM APPLI
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77403
|
Radiation treatment delivery
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
55859
|
Percut/needle insert, pros
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77761
|
HC INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77406
|
Radiation treatment delivery
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77328
|
Brachytx isodose plan compl
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77777
|
Apply interstit radiat inter
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
76873
|
HC PROSTATE VOLUME STUDY
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77402
|
HC RAD TX> 1MEV, SIMPLE
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77763
|
HC INTRACAVITARY RADIATION SOURCE APPLICATION; COMPLEX
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
77776
|
Apply interstit radiat simpl
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
C2641
|
HC Palladium-103 Seed
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table.
|
C1715
|
SET BRACHYTHERAPY 20CM BEVEL 18GA 2 PART HUB DESIGN STABILIZATION
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY11/1997: Approved by the Medical Policy Advisory Committee (MPAC)
8/1999: Addition of medically necessary indication approved by MPAC
5/21/2001: Code Reference section updated, CPT code 55859, 76965 added, ICD-9 procedure code 60.0, 92.28, 92.29 added
7/13/2001: Policy exception for FEP added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
3/7/2003: Code Reference section updated, HCPCS G0256, G0261 added
8/3/2005: Code Reference section updated, CPT code 76873, 77326, 77327, 77328, 77761, 77762, 77763, 77776, 77777, 77778 description revised, CPT code 77799 added, ICD-9 procedure code 60.99 added, ICD-9 procedure code 60.0 deleted, ICD-9 diagnosis code 233.4 description revised, HCPCS Q3001 added, HCPCS G0256, G0261 deleted
12/27/2006: Code Reference section updated per the 2007 CPT revisions
6/26/2007: Code Reference section updated per quarterly HCPCS and Category III revisions
6/18/2009: Policy description updated, policy statement updated. CPT4 codes 77402, 77403 and 77406 added to the covered table. HCPC codes C1715, C 2638,C2639, C2640 and C2641 added to covered table. 7/10/2009: CPT code 77404 added to covered table.
|
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