code
stringlengths 4
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stringlengths 2
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stringclasses 8
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stringlengths 160
15.5k
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|---|---|---|---|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
structured form (progress notes) that allows dr's to document pt encounters into an EHR, once it is entered it must be INTEROPERABLE: must be able to exchange info and use it in a meaningful way, therefore clinical standards are important to the details of pt info
Types of Clinical Standards
-CLINICAL VOCABULARIES- set of common definitions for medical terms, they ease communications by decreasing ambiguity
-SNOMED-CT- clinical vocabulary designed to encompass all terms used in medicine
-LOINC- terms and codes used for electronic exchange of lab results and clinical observations
-UMLS- thesaurus database of medical terms
What are CLASSIFICATION SYSTEMS? they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions
ICD-9 and ICD-10
International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings. DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
structured form (progress notes) that allows dr's to document pt encounters into an EHR, once it is entered it must be INTEROPERABLE: must be able to exchange info and use it in a meaningful way, therefore clinical standards are important to the details of pt info
Types of Clinical Standards
-CLINICAL VOCABULARIES- set of common definitions for medical terms, they ease communications by decreasing ambiguity
-SNOMED-CT- clinical vocabulary designed to encompass all terms used in medicine
-LOINC- terms and codes used for electronic exchange of lab results and clinical observations
-UMLS- thesaurus database of medical terms
What are CLASSIFICATION SYSTEMS? they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions
ICD-9 and ICD-10
International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings. DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list.
|
01999
|
Unlisted anesth procedure
|
CPT
|
structured form (progress notes) that allows dr's to document pt encounters into an EHR, once it is entered it must be INTEROPERABLE: must be able to exchange info and use it in a meaningful way, therefore clinical standards are important to the details of pt info
Types of Clinical Standards
-CLINICAL VOCABULARIES- set of common definitions for medical terms, they ease communications by decreasing ambiguity
-SNOMED-CT- clinical vocabulary designed to encompass all terms used in medicine
-LOINC- terms and codes used for electronic exchange of lab results and clinical observations
-UMLS- thesaurus database of medical terms
What are CLASSIFICATION SYSTEMS? they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions
ICD-9 and ICD-10
International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings. DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions
ICD-9 and ICD-10
International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings. DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list. anatomy
use of the language or the actual words spoken, key components are sound, words, speaking and language.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions
ICD-9 and ICD-10
International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings. DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list. anatomy
use of the language or the actual words spoken, key components are sound, words, speaking and language.
|
01999
|
Unlisted anesth procedure
|
CPT
|
they organize terms into categories for easy retrieval, they are used for billing and reimbursement, statistical reporting and admin functions
ICD-9 and ICD-10
International Classification of Disease-standard developed by World Health Organization (WHO) contains diagnosis codes that are used in all health care settings. DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list. anatomy
use of the language or the actual words spoken, key components are sound, words, speaking and language.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list. anatomy
use of the language or the actual words spoken, key components are sound, words, speaking and language. is the use of eye contact, body lang, facial expressions, or symbolic expressions to communicate a message
essential part in the process of communication w/ coworkers, pt's & visitors.
|
00100
|
ANESTH SALIVARY GLAND
|
CPT
|
DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list. anatomy
use of the language or the actual words spoken, key components are sound, words, speaking and language. is the use of eye contact, body lang, facial expressions, or symbolic expressions to communicate a message
essential part in the process of communication w/ coworkers, pt's & visitors.
|
01999
|
Unlisted anesth procedure
|
CPT
|
DIAGNOSIS USAGE: Inpatient & Outpatient
*Number of characters: 3-5 alphanumeric
*Number of Codes: 13,000
PROCEDURE USAGE: Inpatient*
*# of characters: 3-4 numeric
*# of codes 4,000
DIAGNOSIS USAGE: inpatient & outpatient
*# of characters: 3-7 alphanumeric
*# of codes: 120,00
PROCEDURE USAGE: none
DIAGNOSIS USAGE: none
PROCEDURE USAGE: inpatient
*# of characters: 7 alphanumeric
*# of codes: 200,000
Current Procedural Terminology- list of descriptive terms and identifying codes for reporting medical services and procedures performed by health care professionals in outpatient setting, developed and maintained by American Medical Association (AMA)
CPT Code Ranges
EVALUATION & MANAGEMENT (E&M): 99201-99499 (go to dr feeling 99% leave getting high five)
ANESTHESIA: 00100-01999 (knocked out, always begin w/ 0)
SURGERY: 10021-69990 (want to feel 100%, begins w/ 1)
RADIOLOGY: (RPM, R=7, begins w/ 7)
PATHOLOGY AND LABORATORY: 80047-89356 (RPM. P=8, begins w/ 8)
MEDICINE: 90281-99607 (RPM, M=9, begins w/ 9)
Healthcare Common Procedure Coding System- level II, national codes, contains codes for products, supplies, and certain services not included in CPT. Codes are maintained by Center for Medicare and Medicaid Services (CMS)
-make it possible to transfer data from systems such as lab or pharmacy system, play crucial role in interoperability among info systems
EX: HL7, DICOM, NCPDP AND IEEE1073
Health Level 7 (HL7) Messaging Standards
(messaging standard used to send data from one application to another)-scheduling, medical record & image management, pt administration, observation reporting, financial management, public health notification, and pt care
**units of measure
**Text based reports
Digital Imaging & Communications in Medicine (DICOM) Messaging Standards
image info to workstations (x-rays, nuclear medicine) **standards that enable info exchange between imaging systems**
National Council for Prescription Drug Programs (NCPDP) SCRIPT Messaging Standards
used for retail pharmacy transactions **standard for exchanging prescription info** HIPPA requires use in retail pharmacies
The institute of Electrical and Electronics Engineers 1073 (IEEE1073) Messaging Standard
standard that provides communication among medical devices at pt's bedside (device-device connectivity)
Logical Observation Identifiers Names and Codes (LOINC) Clinical Vocabulary
contains laboratory results names, Interventions/procedures (Part A): Lab test order names
Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Clinical Vocabulary
contains lab results contents, interventions/procedures (Part B): nonlaboratory, diagnosis/problem list. anatomy
use of the language or the actual words spoken, key components are sound, words, speaking and language. is the use of eye contact, body lang, facial expressions, or symbolic expressions to communicate a message
essential part in the process of communication w/ coworkers, pt's & visitors.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY4/1993: Approved by Medical Policy Advisory Committee (MPAC)
2/1997: Expanded clinical indications approved by MPAC. Limited to DEXA method only, once every 12 months. 6/1999: Interim policy revision: Included use of quantitative ultrasound (QUS) as an approved method
8/1999: Addition of QUS approved by MPAC
11/2000: Reviewed by MPAC; no changes
5/21/2001: Code Reference section revised; non-covered codes table added
10/15/2001: Verbiage revised under "policy" section; "Reimbursement is not provided for SPA, DPA or QCT bone densitometry techniques" to "SPA, DPA and QCT bone densitometry techniques are considered investigational and not eligible for coverage." 2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added
3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substantiates need for glucocorticoid reduction remains every 12 months, Sources updated
6/12/2003: Code Reference section updated
8/7/2003: Code Reference section updated, CPT code range 76075-76076 listed separately, fourth and fifth digit added as appropriate to 242.9, 256.3, and 556, ICD-9 diagnosis code ranges listed separately 493.00-493.92, 555.0-555.9, 579.0-579.9, 756.5-756.59, ICD-9 diagnosis codes 491.20 and 491.21 complete descriptions added
8/14/2003: CPT code 76071 added, ICD-9 diagnosis codes 227.3, V07.4 added
7/14/2004: Code Reference section updated, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
POLICY HISTORY4/1993: Approved by Medical Policy Advisory Committee (MPAC)
2/1997: Expanded clinical indications approved by MPAC. Limited to DEXA method only, once every 12 months. 6/1999: Interim policy revision: Included use of quantitative ultrasound (QUS) as an approved method
8/1999: Addition of QUS approved by MPAC
11/2000: Reviewed by MPAC; no changes
5/21/2001: Code Reference section revised; non-covered codes table added
10/15/2001: Verbiage revised under "policy" section; "Reimbursement is not provided for SPA, DPA or QCT bone densitometry techniques" to "SPA, DPA and QCT bone densitometry techniques are considered investigational and not eligible for coverage." 2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added
3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substantiates need for glucocorticoid reduction remains every 12 months, Sources updated
6/12/2003: Code Reference section updated
8/7/2003: Code Reference section updated, CPT code range 76075-76076 listed separately, fourth and fifth digit added as appropriate to 242.9, 256.3, and 556, ICD-9 diagnosis code ranges listed separately 493.00-493.92, 555.0-555.9, 579.0-579.9, 756.5-756.59, ICD-9 diagnosis codes 491.20 and 491.21 complete descriptions added
8/14/2003: CPT code 76071 added, ICD-9 diagnosis codes 227.3, V07.4 added
7/14/2004: Code Reference section updated, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6. 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted
9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 added to covered codes with notation “Bone density measurement, using either the QUS or DEXA technology is considered medically necessary and eligible for coverage once every 12 months for long term glucocorticoid therapy where bone density substantiates a need for glucocorticoid reduction in conditions such as listed above but not limited to the condition above.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
Limited to DEXA method only, once every 12 months. 6/1999: Interim policy revision: Included use of quantitative ultrasound (QUS) as an approved method
8/1999: Addition of QUS approved by MPAC
11/2000: Reviewed by MPAC; no changes
5/21/2001: Code Reference section revised; non-covered codes table added
10/15/2001: Verbiage revised under "policy" section; "Reimbursement is not provided for SPA, DPA or QCT bone densitometry techniques" to "SPA, DPA and QCT bone densitometry techniques are considered investigational and not eligible for coverage." 2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added
3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substantiates need for glucocorticoid reduction remains every 12 months, Sources updated
6/12/2003: Code Reference section updated
8/7/2003: Code Reference section updated, CPT code range 76075-76076 listed separately, fourth and fifth digit added as appropriate to 242.9, 256.3, and 556, ICD-9 diagnosis code ranges listed separately 493.00-493.92, 555.0-555.9, 579.0-579.9, 756.5-756.59, ICD-9 diagnosis codes 491.20 and 491.21 complete descriptions added
8/14/2003: CPT code 76071 added, ICD-9 diagnosis codes 227.3, V07.4 added
7/14/2004: Code Reference section updated, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6. 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted
9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 added to covered codes with notation “Bone density measurement, using either the QUS or DEXA technology is considered medically necessary and eligible for coverage once every 12 months for long term glucocorticoid therapy where bone density substantiates a need for glucocorticoid reduction in conditions such as listed above but not limited to the condition above. Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
6/1999: Interim policy revision: Included use of quantitative ultrasound (QUS) as an approved method
8/1999: Addition of QUS approved by MPAC
11/2000: Reviewed by MPAC; no changes
5/21/2001: Code Reference section revised; non-covered codes table added
10/15/2001: Verbiage revised under "policy" section; "Reimbursement is not provided for SPA, DPA or QCT bone densitometry techniques" to "SPA, DPA and QCT bone densitometry techniques are considered investigational and not eligible for coverage." 2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added
3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substantiates need for glucocorticoid reduction remains every 12 months, Sources updated
6/12/2003: Code Reference section updated
8/7/2003: Code Reference section updated, CPT code range 76075-76076 listed separately, fourth and fifth digit added as appropriate to 242.9, 256.3, and 556, ICD-9 diagnosis code ranges listed separately 493.00-493.92, 555.0-555.9, 579.0-579.9, 756.5-756.59, ICD-9 diagnosis codes 491.20 and 491.21 complete descriptions added
8/14/2003: CPT code 76071 added, ICD-9 diagnosis codes 227.3, V07.4 added
7/14/2004: Code Reference section updated, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6. 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted
9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 added to covered codes with notation “Bone density measurement, using either the QUS or DEXA technology is considered medically necessary and eligible for coverage once every 12 months for long term glucocorticoid therapy where bone density substantiates a need for glucocorticoid reduction in conditions such as listed above but not limited to the condition above. Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid. Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated.
|
76075
|
Dxa bone density, axial
|
HCPCS
|
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added
3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substantiates need for glucocorticoid reduction remains every 12 months, Sources updated
6/12/2003: Code Reference section updated
8/7/2003: Code Reference section updated, CPT code range 76075-76076 listed separately, fourth and fifth digit added as appropriate to 242.9, 256.3, and 556, ICD-9 diagnosis code ranges listed separately 493.00-493.92, 555.0-555.9, 579.0-579.9, 756.5-756.59, ICD-9 diagnosis codes 491.20 and 491.21 complete descriptions added
8/14/2003: CPT code 76071 added, ICD-9 diagnosis codes 227.3, V07.4 added
7/14/2004: Code Reference section updated, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6. 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted
9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 added to covered codes with notation “Bone density measurement, using either the QUS or DEXA technology is considered medically necessary and eligible for coverage once every 12 months for long term glucocorticoid therapy where bone density substantiates a need for glucocorticoid reduction in conditions such as listed above but not limited to the condition above. Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid. Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy
09/13/2006: Coding updated.
|
76071
|
Ct bone density, peripheral
|
HCPCS
|
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added
3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substantiates need for glucocorticoid reduction remains every 12 months, Sources updated
6/12/2003: Code Reference section updated
8/7/2003: Code Reference section updated, CPT code range 76075-76076 listed separately, fourth and fifth digit added as appropriate to 242.9, 256.3, and 556, ICD-9 diagnosis code ranges listed separately 493.00-493.92, 555.0-555.9, 579.0-579.9, 756.5-756.59, ICD-9 diagnosis codes 491.20 and 491.21 complete descriptions added
8/14/2003: CPT code 76071 added, ICD-9 diagnosis codes 227.3, V07.4 added
7/14/2004: Code Reference section updated, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6. 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted
9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 added to covered codes with notation “Bone density measurement, using either the QUS or DEXA technology is considered medically necessary and eligible for coverage once every 12 months for long term glucocorticoid therapy where bone density substantiates a need for glucocorticoid reduction in conditions such as listed above but not limited to the condition above. Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid. Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy
09/13/2006: Coding updated.
|
76077
|
Dxa bone density/v-fracture
|
HCPCS
|
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added
3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substantiates need for glucocorticoid reduction remains every 12 months, Sources updated
6/12/2003: Code Reference section updated
8/7/2003: Code Reference section updated, CPT code range 76075-76076 listed separately, fourth and fifth digit added as appropriate to 242.9, 256.3, and 556, ICD-9 diagnosis code ranges listed separately 493.00-493.92, 555.0-555.9, 579.0-579.9, 756.5-756.59, ICD-9 diagnosis codes 491.20 and 491.21 complete descriptions added
8/14/2003: CPT code 76071 added, ICD-9 diagnosis codes 227.3, V07.4 added
7/14/2004: Code Reference section updated, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6. 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted
9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 added to covered codes with notation “Bone density measurement, using either the QUS or DEXA technology is considered medically necessary and eligible for coverage once every 12 months for long term glucocorticoid therapy where bone density substantiates a need for glucocorticoid reduction in conditions such as listed above but not limited to the condition above. Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid. Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy
09/13/2006: Coding updated.
|
76076
|
Dxa bone density/peripheral
|
HCPCS
|
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 493 and 579 4th/5th digit added
3/2003: Reviewed by MPAC, frequency of all current indications changed to every 2 years except long term glucocortocoid therapy where bone density substantiates need for glucocorticoid reduction remains every 12 months, Sources updated
6/12/2003: Code Reference section updated
8/7/2003: Code Reference section updated, CPT code range 76075-76076 listed separately, fourth and fifth digit added as appropriate to 242.9, 256.3, and 556, ICD-9 diagnosis code ranges listed separately 493.00-493.92, 555.0-555.9, 579.0-579.9, 756.5-756.59, ICD-9 diagnosis codes 491.20 and 491.21 complete descriptions added
8/14/2003: CPT code 76071 added, ICD-9 diagnosis codes 227.3, V07.4 added
7/14/2004: Code Reference section updated, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6. 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted
9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 added to covered codes with notation “Bone density measurement, using either the QUS or DEXA technology is considered medically necessary and eligible for coverage once every 12 months for long term glucocorticoid therapy where bone density substantiates a need for glucocorticoid reduction in conditions such as listed above but not limited to the condition above. Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid. Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy
09/13/2006: Coding updated.
|
76077
|
Dxa bone density/v-fracture
|
HCPCS
|
556.8, 556.9, 558.9, 564.2, 571.49, 714.0 deleted
9/27/2004: Under Policy “chronic” renal failure specified, ICD-9 diagnosis code 491.20, 491.21, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.90, 493.91, 493.92, 496, 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, 556.9, 558.9, 564.2, 571.49, 714.0 added to covered codes with notation “Bone density measurement, using either the QUS or DEXA technology is considered medically necessary and eligible for coverage once every 12 months for long term glucocorticoid therapy where bone density substantiates a need for glucocorticoid reduction in conditions such as listed above but not limited to the condition above. Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid. Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
09/25/2006: Policy clarified and partially rewritten
10/25/2006: Code reference section updated.
|
76077
|
Dxa bone density/v-fracture
|
HCPCS
|
Note: V58.65 Long-term (current) use of steroids,” The examples of conditions listed are covered in addition to other chronic illnesses requiring the long term (current) use of glucocorticoid. Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
09/25/2006: Policy clarified and partially rewritten
10/25/2006: Code reference section updated. CPT code 76077 added to covered table.
|
76077
|
Dxa bone density/v-fracture
|
HCPCS
|
Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
09/25/2006: Policy clarified and partially rewritten
10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified.
|
G0130
|
Single energy x-ray study
|
HCPCS
|
Note “but not limited to” - coding has been listed in the Code Reference section for the examples listed in the Policy section only, ICD-9 diagnosis code 242.00, 242.01, 242.10, 242.11, 242.20, 242.21, 242.30, 242.31, 242.40, 242.41, 242.80, 242.81, 756.10, 756.9 added to covered codes, ICD-9 diagnosis code 252.0 5th digit added “252.01,” ICD-9 diagnosis code 626.0 note added “Amenorrhea of six month's duration associated with extensive exercise and/or anorexia nervosa (ICD-9 diagnosis code 307.1)
3/24/2005: CPT code 76077 with effective date of 1/1/2005 added
8/26/2005: CPT code 76077 deleted
11/8/2005: Code Reference section updated, 4th digit added to ICD9 diagnosis code 585.1-585.9: description revised
03/10/2006: Coding updated. HCPCS 2006 revisions added to policy
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
09/25/2006: Policy clarified and partially rewritten
10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified.
|
76077
|
Dxa bone density/v-fracture
|
HCPCS
|
HCPCS 2006 revisions added to policy
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
09/25/2006: Policy clarified and partially rewritten
10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated.
|
G0130
|
Single energy x-ray study
|
HCPCS
|
HCPCS 2006 revisions added to policy
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
09/25/2006: Policy clarified and partially rewritten
10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated.
|
76077
|
Dxa bone density/v-fracture
|
HCPCS
|
ICD9 2006 revisions added to policy
09/25/2006: Policy clarified and partially rewritten
10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table.
|
G0130
|
Single energy x-ray study
|
HCPCS
|
ICD9 2006 revisions added to policy
09/25/2006: Policy clarified and partially rewritten
10/25/2006: Code reference section updated. CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table.
|
76075
|
Dxa bone density, axial
|
HCPCS
|
CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006.
|
76077
|
Dxa bone density/v-fracture
|
HCPCS
|
CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006.
|
G0130
|
Single energy x-ray study
|
HCPCS
|
CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006.
|
76076
|
Dxa bone density/peripheral
|
HCPCS
|
CPT code 76077 added to covered table. HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006.
|
76075
|
Dxa bone density, axial
|
HCPCS
|
HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006. HCPC code Q9952 deleted from covered table due to code was deleted as of 12-31-2007.
|
Q9952
|
Inj Gad-base MR contrast,1ml
|
HCPCS
|
HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006. HCPC code Q9952 deleted from covered table due to code was deleted as of 12-31-2007.
|
G0130
|
Single energy x-ray study
|
HCPCS
|
HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006. HCPC code Q9952 deleted from covered table due to code was deleted as of 12-31-2007.
|
76076
|
Dxa bone density/peripheral
|
HCPCS
|
HCPC code G0130 added to non-covered table
12/21/2006: Policy clarified. Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006. HCPC code Q9952 deleted from covered table due to code was deleted as of 12-31-2007.
|
76075
|
Dxa bone density, axial
|
HCPCS
|
Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006. HCPC code Q9952 deleted from covered table due to code was deleted as of 12-31-2007. 12/22/2009: Title revised to include “Mineral.” Description Section updated to add Quantitative Computed Tomography (QCT) and Ultrasound Densitometry, removed Quantitative Ultrasound.
|
Q9952
|
Inj Gad-base MR contrast,1ml
|
HCPCS
|
Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006. HCPC code Q9952 deleted from covered table due to code was deleted as of 12-31-2007. 12/22/2009: Title revised to include “Mineral.” Description Section updated to add Quantitative Computed Tomography (QCT) and Ultrasound Densitometry, removed Quantitative Ultrasound.
|
76076
|
Dxa bone density/peripheral
|
HCPCS
|
Added "including, but not limited to, women 60 years of age or older" to women deficient in estrogen following menopause
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated.CPT/HCPCS 2008 revisions added to policy
9/17/2008: Annual ICD-9 updates effective 10-1-2008 applied
9/28/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. CPT codes 76075 and 76076 deleted from covered table due to codes were deleted as of 12-31-2006. HCPC code Q9952 deleted from covered table due to code was deleted as of 12-31-2007. 12/22/2009: Title revised to include “Mineral.” Description Section updated to add Quantitative Computed Tomography (QCT) and Ultrasound Densitometry, removed Quantitative Ultrasound.
|
L7190
|
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
|
HCPCS
|
07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section.
|
L7191
|
Electronic elbow, child, variety village or equal, myoelectronically controlled
|
HCPCS
|
07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section.
|
L6880
|
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
|
HCPCS
|
07/19/2012: Policy title changed back to "Myoelectric Prosthesis for the Upper Limb." Added the following policy statement: A prosthesis with individually powered digits, including but not limited to a partial hand prosthesis, is considered investigational. 09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section.
|
L7190
|
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
|
HCPCS
|
09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged.
|
L7191
|
Electronic elbow, child, variety village or equal, myoelectronically controlled
|
HCPCS
|
09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged.
|
L6880
|
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
|
HCPCS
|
09/03/2013: Policy title changed from "Myoelectric Prosthesis for the Upper Limb" to "Myoelectric Prosthetic Components for the Upper Limb." Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged.
|
L6026
|
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr
|
HCPCS
|
Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026.
|
L7190
|
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled
|
HCPCS
|
Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026.
|
L7191
|
Electronic elbow, child, variety village or equal, myoelectronically controlled
|
HCPCS
|
Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026.
|
L6880
|
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)
|
HCPCS
|
Policy statement unchanged. Added HCPCS codes L6880, L7190, and L7191 to the Code Reference section. 08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026.
|
L6026
|
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr
|
HCPCS
|
08/14/2014: Policy reviewed; description updated regarding devices. Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. SOURCESBlue Cross Blue Shield Association policy # 1.04.04
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
|
L6026
|
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr
|
HCPCS
|
Policy statement unchanged. 12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. SOURCESBlue Cross Blue Shield Association policy # 1.04.04
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
|
L6026
|
Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectr
|
HCPCS
|
12/31/2014: Added the following new 2015 HCPCS code to the Code Reference section: L6026. 08/26/2015: Medical policy revised to add ICD-10 codes. SOURCESBlue Cross Blue Shield Association policy # 1.04.04
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
|
0049T
|
External circulation assist
|
CPT
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
33978
|
Remove ventricular device
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
33977
|
Remove ventricular device
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
0052T
|
Replace thrc unit hrt syst
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
33976
|
PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
33975
|
PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
0050T
|
Removal circulation assist
|
CPT
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
0053T
|
Replace implantable hrt syst
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
Q0480
|
Driver pneumatic vad, rep
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
0048T
|
Implant ventricular device
|
CPT
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
0051T
|
Implant total heart system
|
HCPCS
|
In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology 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 HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised.
|
0049T
|
External circulation assist
|
CPT
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
33978
|
Remove ventricular device
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
33977
|
Remove ventricular device
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
0052T
|
Replace thrc unit hrt syst
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
33976
|
PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
33975
|
PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
0050T
|
Removal circulation assist
|
CPT
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
0053T
|
Replace implantable hrt syst
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
Q0480
|
Driver pneumatic vad, rep
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
0048T
|
Implant ventricular device
|
CPT
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
0051T
|
Implant total heart system
|
HCPCS
|
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy.
|
0049T
|
External circulation assist
|
CPT
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
33978
|
Remove ventricular device
|
HCPCS
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
33977
|
Remove ventricular device
|
HCPCS
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
0052T
|
Replace thrc unit hrt syst
|
HCPCS
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
33976
|
PR INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR
|
HCPCS
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
33975
|
PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE
|
HCPCS
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
0050T
|
Removal circulation assist
|
CPT
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
0053T
|
Replace implantable hrt syst
|
HCPCS
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
Q0480
|
Driver pneumatic vad, rep
|
HCPCS
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
0048T
|
Implant ventricular device
|
CPT
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
0051T
|
Implant total heart system
|
HCPCS
|
POLICY HISTORY8/1998: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
3/2003: Reviewed by MPAC; Policy title "Ventricular Assist Devices as a Bridge to Heart Transplantation" renamed "Ventricular Assist Devices", LVAD as a "destination" therapy considered investigational. FEP exception added
7/24/2003: Code References section updated, ICD-9 procedure code 37.61 deleted, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 added covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 added non-covered codes
3/2004: Reviewed by MPAC, coverage remains as written with policy statement added to limit medically necessary indications to FDA approved ventricular assist devices, total artificial hearts are considered investigational, Policy title “Ventricular Assist Devices” renamed “Ventricular Assist Devices and Total Artificial Hearts", Description section revised to be consistent with BCBSA policy # 7.03.11, FEP exceptions added, Sources added, “contraindications” moved from Policy to Policy Guidelines section
10/13/2004: Code Reference section updated, CPT code 0048T, 0049T, 0050T added covered codes, CPT 33975, 33976, 33977, 33978 description revised, ICD-9 procedure code 37.62, 37.63, 37.66 description revised, ICD-9 procedure code 37.68 added, ICD-9 diagnosis 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9 deleted covered codes, CPT 0051T, 0052T, 0053T added non-covered codes, ICD-9 procedure code 37.52, 37.53, 37.54 added non-covered codes, ICD-9 diagnosis 038.0-038.9, 042, 090.0-097.9, 112.5, 117.5, 280.0-282.63, 282.69-289.51, 289.59-289.9, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 518.83, 518.84, 570, 571.0, 571.1, 571.2, 571.3, 572.4, 572.8, 585 deleted non-covered codes
11/11/2005: Code Reference section updated, HCPCS codes Q0480-Q0505 added
4/10/2006: Policy reviewed, no change to policy. Q0480-Q0505 already added to policy
9/6/2006: Policy updated to include information on the AbioCor artificial heart
9/18/2006: Coding revised. ICD9 2006 revisions added to policy. 5/7/2008: Policy description updated.
|
0053T
|
Replace implantable hrt syst
|
HCPCS
|
Ventricular assist devices as destination therapy with end-stage heart failure changed from investigational to medically necessary for FDA-approved devices in patients ineligible for human heart transplant. Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. ICD-9 procedure codes 37.52-37.54 moved to covered
9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions
8/19/2009: Policy reviewed, no changes
03/12/2010: Coding Section revised for 2010 CPT4 and HCPCS revision
12/30/2010: Policy description re-written. Policy statements revised to address only implantable VADs and total artificial hearts.
|
0051T
|
Implant total heart system
|
HCPCS
|
Ventricular assist devices as destination therapy with end-stage heart failure changed from investigational to medically necessary for FDA-approved devices in patients ineligible for human heart transplant. Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. ICD-9 procedure codes 37.52-37.54 moved to covered
9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions
8/19/2009: Policy reviewed, no changes
03/12/2010: Coding Section revised for 2010 CPT4 and HCPCS revision
12/30/2010: Policy description re-written. Policy statements revised to address only implantable VADs and total artificial hearts.
|
Q4079
|
Natalizumab injection
|
HCPCS
|
Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. ICD-9 procedure codes 37.52-37.54 moved to covered
9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions
8/19/2009: Policy reviewed, no changes
03/12/2010: Coding Section revised for 2010 CPT4 and HCPCS revision
12/30/2010: Policy description re-written. Policy statements revised to address only implantable VADs and total artificial hearts. 03/09/2011: Added new HCPCS codes Q4078 and Q4079 to the Code Reference section.
|
0053T
|
Replace implantable hrt syst
|
HCPCS
|
Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. ICD-9 procedure codes 37.52-37.54 moved to covered
9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions
8/19/2009: Policy reviewed, no changes
03/12/2010: Coding Section revised for 2010 CPT4 and HCPCS revision
12/30/2010: Policy description re-written. Policy statements revised to address only implantable VADs and total artificial hearts. 03/09/2011: Added new HCPCS codes Q4078 and Q4079 to the Code Reference section.
|
0051T
|
Implant total heart system
|
HCPCS
|
Other policy statements revised for clarity; coverage remains the same. CPT codes 0051T-0053T moved to covered. ICD-9 procedure codes 37.52-37.54 moved to covered
9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions
8/19/2009: Policy reviewed, no changes
03/12/2010: Coding Section revised for 2010 CPT4 and HCPCS revision
12/30/2010: Policy description re-written. Policy statements revised to address only implantable VADs and total artificial hearts. 03/09/2011: Added new HCPCS codes Q4078 and Q4079 to the Code Reference section.
|
Q4079
|
Natalizumab injection
|
HCPCS
|
ICD-9 procedure codes 37.52-37.54 moved to covered
9/22/2008: Annual ICD-9 updates effective 10-1-2008 applied
12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions
8/19/2009: Policy reviewed, no changes
03/12/2010: Coding Section revised for 2010 CPT4 and HCPCS revision
12/30/2010: Policy description re-written. Policy statements revised to address only implantable VADs and total artificial hearts. 03/09/2011: Added new HCPCS codes Q4078 and Q4079 to the Code Reference section. 12/13/2011: Policy description and statement updated regarding percutaneous ventricular assist devices. Added the following policy statement: Percutaneous ventricular assist devices (pVADs) are considered investigational for all indications.
|
Q4079
|
Natalizumab injection
|
HCPCS
|
Policy statements revised to address only implantable VADs and total artificial hearts. 03/09/2011: Added new HCPCS codes Q4078 and Q4079 to the Code Reference section. 12/13/2011: Policy description and statement updated regarding percutaneous ventricular assist devices. Added the following policy statement: Percutaneous ventricular assist devices (pVADs) are considered investigational for all indications. 11/30/2012: Added the verbiage "or are undergoing evaluation to determine candidacy for heart transplantation" to the policy statement regarding total artificial hearts.
|
0048T
|
Implant ventricular device
|
CPT
|
Replaced "cleared devices" with "clearance." Added "Implantable" to the beggining of the policy statement under the Bridge to Transplantation section. Policy statement on implantable VADs as a bridge to heart tranplantation in children was revised to change the age range from "5 to 16" to "16 years old or younger," reflecting the approval of the BERLIN heart EXCOR device for pediatric patients. Policy guidelines updated to include coagulation disorders and inadequate psychosocial support as contraindications for bridge to transplant VADs and TAH. Removed deleted CPT codes 0048T and 0050T from the Code Reference section.
|
0050T
|
Removal circulation assist
|
CPT
|
Replaced "cleared devices" with "clearance." Added "Implantable" to the beggining of the policy statement under the Bridge to Transplantation section. Policy statement on implantable VADs as a bridge to heart tranplantation in children was revised to change the age range from "5 to 16" to "16 years old or younger," reflecting the approval of the BERLIN heart EXCOR device for pediatric patients. Policy guidelines updated to include coagulation disorders and inadequate psychosocial support as contraindications for bridge to transplant VADs and TAH. Removed deleted CPT codes 0048T and 0050T from the Code Reference section.
|
0048T
|
Implant ventricular device
|
CPT
|
Policy statement on implantable VADs as a bridge to heart tranplantation in children was revised to change the age range from "5 to 16" to "16 years old or younger," reflecting the approval of the BERLIN heart EXCOR device for pediatric patients. Policy guidelines updated to include coagulation disorders and inadequate psychosocial support as contraindications for bridge to transplant VADs and TAH. Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 33990, 33991, 33992, 33993 and ICD-9 procedure code 37.68 moved from Covered to Investigational.
|
0050T
|
Removal circulation assist
|
CPT
|
Policy statement on implantable VADs as a bridge to heart tranplantation in children was revised to change the age range from "5 to 16" to "16 years old or younger," reflecting the approval of the BERLIN heart EXCOR device for pediatric patients. Policy guidelines updated to include coagulation disorders and inadequate psychosocial support as contraindications for bridge to transplant VADs and TAH. Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 33990, 33991, 33992, 33993 and ICD-9 procedure code 37.68 moved from Covered to Investigational.
|
0048T
|
Implant ventricular device
|
CPT
|
Policy guidelines updated to include coagulation disorders and inadequate psychosocial support as contraindications for bridge to transplant VADs and TAH. Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 33990, 33991, 33992, 33993 and ICD-9 procedure code 37.68 moved from Covered to Investigational. 08/27/2015: Code Reference section updated for ICD-10.
|
0050T
|
Removal circulation assist
|
CPT
|
Policy guidelines updated to include coagulation disorders and inadequate psychosocial support as contraindications for bridge to transplant VADs and TAH. Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 33990, 33991, 33992, 33993 and ICD-9 procedure code 37.68 moved from Covered to Investigational. 08/27/2015: Code Reference section updated for ICD-10.
|
0048T
|
Implant ventricular device
|
CPT
|
Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 33990, 33991, 33992, 33993 and ICD-9 procedure code 37.68 moved from Covered to Investigational. 08/27/2015: Code Reference section updated for ICD-10. Removed deleted CPT code Q0505.
|
0050T
|
Removal circulation assist
|
CPT
|
Removed deleted CPT codes 0048T and 0050T from the Code Reference section. 07/07/2015: Code Reference section updated to add Investigational Codes table. CPT codes 33990, 33991, 33992, 33993 and ICD-9 procedure code 37.68 moved from Covered to Investigational. 08/27/2015: Code Reference section updated for ICD-10. Removed deleted CPT code Q0505.
|
70542
|
MRI scan of bone of eye socket, face, and/or neck with contrast
|
HCPCS
|
This is in accordance with the findings of Ayache and associates (2000) who concluded that assessment of perilymphatic pressure does not seem to be useful in Meniere's disease. Furthermore, Rosingh and co-workers (2000) reported that perilymphatic pressure measured in the affected ear of patients with Meniere's disease or idiopathic sudden sensori-neural hearing loss did not differ significantly from the pressure in the non-affected and normal hearing ear. In a follow-up study by Ayache et al (2002), the authors concluded that perilymphatic pressure measurements by means of the Tympanic Displacement Analyzer are not useful in the evaluation of patients with Meniere’s disease. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|Other CPT codes related to the CPB:|
|70540||Magnetic resonance (e.g., proton) imaging, orbit, face, and/or neck; without contrast material(s)|
|70542||with contrast material(s)|
|92585||Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive|
|92587||Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)|
|92588||comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies)|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H81.10 - H81.13
H81.311 - H81.49
|H83.11 - H83.19||Labyrinthine fistula|
|H83.3X1 - H83.3X9||Noise effects on inner ear|
|H90.3||Sensorineural hearing loss, bilateral|
|H90.41 - H90.42||Sensorineural hearing loss, unilateral, with unrestricted hearing on the contralateral side|
|H90.5||Unspecified sensorineural hearing loss|
|H90.6 - H90.8||Mixed conductive and sensorineural hearing loss|
|H91.20 - H91.23||Sudden idiopathic hearing loss|
|H91.8X1 - H91.8X9||Other specified hearing loss|
|H93.11 - H93.19||Tinnitus|
|R26.89||Other abnormalities of gait and mobility [imbalance]|
|R42||Dizziness and giddiness|
|ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):|
|Z01.10||Encounter for examination of ears and hearing without abnormal findings [routine screen without signs/symptoms]|
|Z01.110||Encounter for hearing examination following failed hearing screening [routine screen without signs/symptoms]|
Perilymphatic Pressure Measurement
|
92588
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
HCPCS
|
This is in accordance with the findings of Ayache and associates (2000) who concluded that assessment of perilymphatic pressure does not seem to be useful in Meniere's disease. Furthermore, Rosingh and co-workers (2000) reported that perilymphatic pressure measured in the affected ear of patients with Meniere's disease or idiopathic sudden sensori-neural hearing loss did not differ significantly from the pressure in the non-affected and normal hearing ear. In a follow-up study by Ayache et al (2002), the authors concluded that perilymphatic pressure measurements by means of the Tympanic Displacement Analyzer are not useful in the evaluation of patients with Meniere’s disease. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|Other CPT codes related to the CPB:|
|70540||Magnetic resonance (e.g., proton) imaging, orbit, face, and/or neck; without contrast material(s)|
|70542||with contrast material(s)|
|92585||Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive|
|92587||Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)|
|92588||comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies)|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H81.10 - H81.13
H81.311 - H81.49
|H83.11 - H83.19||Labyrinthine fistula|
|H83.3X1 - H83.3X9||Noise effects on inner ear|
|H90.3||Sensorineural hearing loss, bilateral|
|H90.41 - H90.42||Sensorineural hearing loss, unilateral, with unrestricted hearing on the contralateral side|
|H90.5||Unspecified sensorineural hearing loss|
|H90.6 - H90.8||Mixed conductive and sensorineural hearing loss|
|H91.20 - H91.23||Sudden idiopathic hearing loss|
|H91.8X1 - H91.8X9||Other specified hearing loss|
|H93.11 - H93.19||Tinnitus|
|R26.89||Other abnormalities of gait and mobility [imbalance]|
|R42||Dizziness and giddiness|
|ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):|
|Z01.10||Encounter for examination of ears and hearing without abnormal findings [routine screen without signs/symptoms]|
|Z01.110||Encounter for hearing examination following failed hearing screening [routine screen without signs/symptoms]|
Perilymphatic Pressure Measurement
|
92587
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
HCPCS
|
This is in accordance with the findings of Ayache and associates (2000) who concluded that assessment of perilymphatic pressure does not seem to be useful in Meniere's disease. Furthermore, Rosingh and co-workers (2000) reported that perilymphatic pressure measured in the affected ear of patients with Meniere's disease or idiopathic sudden sensori-neural hearing loss did not differ significantly from the pressure in the non-affected and normal hearing ear. In a follow-up study by Ayache et al (2002), the authors concluded that perilymphatic pressure measurements by means of the Tympanic Displacement Analyzer are not useful in the evaluation of patients with Meniere’s disease. |CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|Other CPT codes related to the CPB:|
|70540||Magnetic resonance (e.g., proton) imaging, orbit, face, and/or neck; without contrast material(s)|
|70542||with contrast material(s)|
|92585||Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive|
|92587||Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products)|
|92588||comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies)|
|ICD-10 codes covered if selection criteria are met:|
|H81.01 - H81.09||Meniere's disease|
|H81.10 - H81.13
H81.311 - H81.49
|H83.11 - H83.19||Labyrinthine fistula|
|H83.3X1 - H83.3X9||Noise effects on inner ear|
|H90.3||Sensorineural hearing loss, bilateral|
|H90.41 - H90.42||Sensorineural hearing loss, unilateral, with unrestricted hearing on the contralateral side|
|H90.5||Unspecified sensorineural hearing loss|
|H90.6 - H90.8||Mixed conductive and sensorineural hearing loss|
|H91.20 - H91.23||Sudden idiopathic hearing loss|
|H91.8X1 - H91.8X9||Other specified hearing loss|
|H93.11 - H93.19||Tinnitus|
|R26.89||Other abnormalities of gait and mobility [imbalance]|
|R42||Dizziness and giddiness|
|ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):|
|Z01.10||Encounter for examination of ears and hearing without abnormal findings [routine screen without signs/symptoms]|
|Z01.110||Encounter for hearing examination following failed hearing screening [routine screen without signs/symptoms]|
Perilymphatic Pressure Measurement
|
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