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L2768
|
Orthotic side bar disconnect device, per bar
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
28300
|
PR OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
|
HCPCS
|
A cast is placed on the foot during the tenotomy procedure, but this is not billable because it’s not a separately identifiable procedure. More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly.
|
28309
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L1960
|
HC SUPPLY ANKLE FOOT ORTHOSIS POSTERIOR SOLID ANKLE CUSTOM - L1960
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
28285
|
Repair of hammertoe
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L2300
|
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L2280
|
Molded inner boot
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L2768
|
Orthotic side bar disconnect device, per bar
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
28300
|
PR OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION
|
HCPCS
|
More extensive procedures may be necessary if the deformity is severe. Some examples of these are hammertoe correction (28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) and osteotomies (code range 28300-28309, depending on the affected bones in the foot). DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky.
|
L1960
|
HC SUPPLY ANKLE FOOT ORTHOSIS POSTERIOR SOLID ANKLE CUSTOM - L1960
|
HCPCS
|
DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
|
L2300
|
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
|
HCPCS
|
DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
|
L2280
|
Molded inner boot
|
HCPCS
|
DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
|
L2768
|
Orthotic side bar disconnect device, per bar
|
HCPCS
|
DME Supply Coding
For the bracing, the following HCPCS Level II supply codes may be used, as prescribed by the physician:
L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated
L2280 Addition to lower extremity, molded inner boot
L2300 Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable
L2768 Orthotic side bar disconnect device, per bar
Billing these codes depends on your facility’s DME status, and if you are billing for the orthotic providers that create the boots and ankle-foot orthosis (AFOs), also known as foot-drop braces. As the child grows, new AFOs and bigger bars will be required and may be billed, accordingly. ICD-10-CM coding for clubfoot is tricky. If you look for “clubfoot” in the ICD-10-CM Alphabetic Index, you’ll see Clubfoot (congenital) Q66.89. When you reference the Tabular List, however, Q66.89 describes other specified congenital deformities of the feet.
|
G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
- 4th digit of “1” defines lower urinary tract symptoms (LUTS), and directs the coder to use an additional code for the associated symptoms, when specified. - R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416.
|
G0419
|
Sat biopsy prostate: >60
|
CPT
|
- 4th digit of “1” defines lower urinary tract symptoms (LUTS), and directs the coder to use an additional code for the associated symptoms, when specified. - R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416.
|
88305
|
Tissue exam by pathologist
|
HCPCS
|
- R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015.
|
G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
- R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015.
|
G0419
|
Sat biopsy prostate: >60
|
CPT
|
- R33 is the primary descriptor for retention of urine. - 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015.
|
88305
|
Tissue exam by pathologist
|
HCPCS
|
- 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies.
|
G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
- 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies.
|
G0419
|
Sat biopsy prostate: >60
|
CPT
|
- 4th digit of “8” defines the urinary retention as “Other”, and includes an instructional note to code first, if applicable, any causal condition such as: enlarged prostate (N40.1). CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies.
|
88305
|
Tissue exam by pathologist
|
HCPCS
|
CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. G0416 is now the appropriate code for all prostate needle biopsies regardless of the number of biopsies/cores.
|
G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. G0416 is now the appropriate code for all prostate needle biopsies regardless of the number of biopsies/cores.
|
G0419
|
Sat biopsy prostate: >60
|
CPT
|
CPT Codes & Guideline for Coding
- HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. - “Medicare has decided to combine reporting of prostate biopsies regardless of number of specimens under revised code G0416. 88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. G0416 is now the appropriate code for all prostate needle biopsies regardless of the number of biopsies/cores.
|
G0417
|
Sat biopsy prostate 21-40
|
CPT
|
88305 should not be used for the analyses of prostate biopsies for Medicare patients with dates of service on or after Jan. 1, 2015.”
Prostate biopsies were “separated” from other surgical specimens listed in 88305, even though they are still listed in the CPT code for 2015. Medicare no longer pays 88305 for prostate needle biopsies. G0416 is now the appropriate code for all prostate needle biopsies regardless of the number of biopsies/cores. G0416– Surgical pathology, gross and micro exam for prostate needle saturation biopsy sampling 1-20 specimens. G0417- ” 21-40 specimens.
|
G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
G0418- ” 41-60 specimens. G0419- ” greater than 60 specimens. NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes.
|
G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
G0419- ” greater than 60 specimens. NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure.
|
88305
|
Tissue exam by pathologist
|
HCPCS
|
NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more.
|
G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more.
|
G0419
|
Sat biopsy prostate: >60
|
CPT
|
NOTE : G0416 to Medicare for TURP specimens. However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more.
|
88305
|
Tissue exam by pathologist
|
HCPCS
|
However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens.
|
G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens.
|
G0419
|
Sat biopsy prostate: >60
|
CPT
|
However, per the code descriptor, (Surgical pathology, gross and microscopic examinations for prostate needle biopsy, any method), G0416 is specific to needle core biopsy samples, and not appropriate for TURP specimens. As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens.
|
88305
|
Tissue exam by pathologist
|
HCPCS
|
As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit.
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G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit.
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G0419
|
Sat biopsy prostate: >60
|
CPT
|
As of January 1, 2012 CMS has issued new guidance in the NCCI Policy Manual regarding these HCPCS codes. It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit.
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88305
|
Tissue exam by pathologist
|
HCPCS
|
It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. For a physician practice that typically bills for more than 6 specimens for a prostate case, you will see reimbursement capped at 5.0 units.
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G0416
|
SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD
|
HCPCS
|
It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. For a physician practice that typically bills for more than 6 specimens for a prostate case, you will see reimbursement capped at 5.0 units.
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G0419
|
Sat biopsy prostate: >60
|
CPT
|
It states:
HCPCS codes G0416-G0419 describe surgical pathology, including gross and microscopic examination, of prostate needle biopsies from a saturation biopsy sampling procedure. CMS requires that these codes rather than CPT code 88305 be utilised to report surgical pathology on prostate needle biopsy specimens only if the number of separately identified needle biopsy specimens is five or more. Surgical pathology on four or fewer prostate needle biopsy specimens should be reported with CPT code 88305 with the unit of service corresponding to the number of separately identified biopsy specimens. The Medicare Physician Fee Schedule National Payment Amount for G0416-26 is $182.10 which is equivalent to 5 units of 88305-26 which has a National Payment Amount of $36.08 per unit. For a physician practice that typically bills for more than 6 specimens for a prostate case, you will see reimbursement capped at 5.0 units.
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92508
|
Speech/hearing therapy
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
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92524
|
ST SPEECH BEHAVIORAL QUALI OF
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
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92522
|
ST SPEECH EVAL OF SOUND PRODUC
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
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T1023
|
PR PROGRAM INTAKE ASSESSMENT
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
T1027
|
HC Family Support Individ 15min
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92523
|
ST SPEECH EVAL SOUND W LANGUAG COMPREHEN
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92610
|
ST SWALLOWING EVALUATION
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
S9152
|
Speech therapy, re-eval
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
S9128
|
Speech therapy, in the home,
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
H2014
|
Skills train and dev, 15 min
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
T1028
|
Home environment assessment
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92507
|
Treatment of speech, language, voice, communication, and/or hearing processing disorder
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92521
|
ST SPEECH EVAL OF FLUENCY
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
92526
|
TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
G0153
|
HHCP-svs of s/l path,ea 15mn
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
T2024
|
Serv asmnt/care plan waiver
|
HCPCS
|
Missing or incomplete documentation can lead to claim denial. - When using time-based codes, the audiologist has to properly list evaluation start and end times in the patient’s medical record. Speech Therapy and Early Intervention Programs – CPT and HCPCS Codes
CPT codes for speech and language evaluations include:
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
92526 Treatment of swallowing dysfunction and/or oral function for feeding
92610 Evaluation of oral and pharyngeal swallowing function
HCPCS Codes for Speech Therapy
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem
S9152 Speech therapy, re-evaluation
Other HCPCS codes for Early Intervention Services/Birth to Three
H2014 Skills training and development, per 15 minutes
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
T1027 Family training and counseling for child development, per 15 minutes
T1028 Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs
T2024 Service assessment/plan of care development, waiver
It is evident that understanding the specific early evaluation program as well as payer guidelines is necessary to ensure accurate billing and appropriate reimbursement for these services. With extensive and updated knowledge about the different types of early intervention services and their codes as well as payer requirements, an experienced medical billing company can help providers overcome the unique challenges reporting these services on claims.
|
96115
|
Neurobehavior status exam
|
HCPCS
|
References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
|
96117
|
NEUROPSYCH TEST BATTERY
|
CPT
|
References were updated.|
|Reviewed||08/23/2007||MPTAC review. References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
|
96115
|
Neurobehavior status exam
|
HCPCS
|
References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
| || || |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing|
|
96117
|
NEUROPSYCH TEST BATTERY
|
CPT
|
References were updated. Coding updated; removed CPT 96115, 96117 deleted 12/31/2005.|
|Reviewed||09/14/2006||MPTAC review. References were updated.|
| ||01/01/2006||Updated coding section with 01/01/2006 CPT/HCPCS changes|
| ||11/22/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||09/22/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. |
| || || |
|Last Review Date||Document Number||Title|
| || ||None|
|Anthem BCBS NH||Draft||Local Region UM Document||Neuropsychological Testing|
|Anthem BCBS West Region||08/12/2004||Local Region UM Document UMR.002||Neuropsychological Testing|
|WellPoint Health Networks, Inc.||09/23/2004||Clinical Guideline ||Neuropsychological Testing|
|
1745
|
Thoracoscopic robotic assisted procedure
|
ICD
|
The Monmouth and Ocean County breast cancer death rate in the past two decades was 20.1% above the U.S., but 4.5% below for all causes other than cancer (Table 5). These differences are consistent for young, middle-aged, and older women. Mortality, Monmouth/Ocean Counties vs. U.S.
From Cancer and From All Other Causes, 1985-2003
|All Cancers||Cancer||% Local is +/- U.S.|
|Age 0-14||133||+13.4||– 31.7|
|Age 15-44||1745||+12.0||– 16.4|
|All- Whites||51430||+10.7||– 3.8|
|All- Blacks||2478||+ 5.3||+ 0.4|
|Breast Cancer (white females)|
|Age 25-44||263||+19.6||– 12.9|
|Age 45-64||1223||+18.9||– 5.0|
|Age 65+||3000||+21.7||– 3.2|
|All Ages||4486||+20.1||– 4.5|
|Source: U.S. Centers for Disease Control and Prevention, http://wonder.cdc.gov, underlying cause of death. Uses ICD-9 cancer codes 140.0-208.9 (1994-1998) and ICD-10 cancer codes C00-C97.9 (1999-2003). Uses ICD-9 breast cancer codes 174.0-174.9 (1994-1998) and ICD-10 cancer codes C50-C50.9 (1999-2003).
|
1745
|
Thoracoscopic robotic assisted procedure
|
ICD
|
These differences are consistent for young, middle-aged, and older women. Mortality, Monmouth/Ocean Counties vs. U.S.
From Cancer and From All Other Causes, 1985-2003
|All Cancers||Cancer||% Local is +/- U.S.|
|Age 0-14||133||+13.4||– 31.7|
|Age 15-44||1745||+12.0||– 16.4|
|All- Whites||51430||+10.7||– 3.8|
|All- Blacks||2478||+ 5.3||+ 0.4|
|Breast Cancer (white females)|
|Age 25-44||263||+19.6||– 12.9|
|Age 45-64||1223||+18.9||– 5.0|
|Age 65+||3000||+21.7||– 3.2|
|All Ages||4486||+20.1||– 4.5|
|Source: U.S. Centers for Disease Control and Prevention, http://wonder.cdc.gov, underlying cause of death. Uses ICD-9 cancer codes 140.0-208.9 (1994-1998) and ICD-10 cancer codes C00-C97.9 (1999-2003). Uses ICD-9 breast cancer codes 174.0-174.9 (1994-1998) and ICD-10 cancer codes C50-C50.9 (1999-2003). All age data adjusted to 2000 U.S. standard population.
|
1745
|
Thoracoscopic robotic assisted procedure
|
ICD
|
Mortality, Monmouth/Ocean Counties vs. U.S.
From Cancer and From All Other Causes, 1985-2003
|All Cancers||Cancer||% Local is +/- U.S.|
|Age 0-14||133||+13.4||– 31.7|
|Age 15-44||1745||+12.0||– 16.4|
|All- Whites||51430||+10.7||– 3.8|
|All- Blacks||2478||+ 5.3||+ 0.4|
|Breast Cancer (white females)|
|Age 25-44||263||+19.6||– 12.9|
|Age 45-64||1223||+18.9||– 5.0|
|Age 65+||3000||+21.7||– 3.2|
|All Ages||4486||+20.1||– 4.5|
|Source: U.S. Centers for Disease Control and Prevention, http://wonder.cdc.gov, underlying cause of death. Uses ICD-9 cancer codes 140.0-208.9 (1994-1998) and ICD-10 cancer codes C00-C97.9 (1999-2003). Uses ICD-9 breast cancer codes 174.0-174.9 (1994-1998) and ICD-10 cancer codes C50-C50.9 (1999-2003). All age data adjusted to 2000 U.S. standard population. All differences statistically significant at p<.05 except for all cancers for blacks.|
The five most common causes of death (circulatory disease, cancer, respiratory disease, accidents/suicide/homicide, and nervous system diseases) account for about 83% of all death nationally.
|
1749
|
Other and unspecified robotic assisted procedure
|
ICD
|
Hyperpigmentation Classification and external resources ICD-10 L81.0-L81.4 ICD-9 709.0 DiseasesDB 24638 MeSH D017495
Hyperpigmentation may be caused by sun damage, inflammation, or other skin injuries, including those related to acne vulgaris. People with darker Asian, Mediterranean or African skin tones are also more prone to hyperpigmentation, especially if they have excess sun exposure. Many forms of hyperpigmentation are caused by an excess production of melanin.
|
0920
|
Other Diagnostic Services - General Classification
|
RC
|
- Myocardial infarction
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA), right coronary artery = RCA. ICD-10 I21-I22 ICD-9 410 DiseasesDB 8664 MedlinePlus 000195 eMedicine med/1567 emerg/327 ped/2520 MeSH D009203
Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery.
|
0195
|
Subacute
|
RC
|
- Myocardial infarction
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA), right coronary artery = RCA. ICD-10 I21-I22 ICD-9 410 DiseasesDB 8664 MedlinePlus 000195 eMedicine med/1567 emerg/327 ped/2520 MeSH D009203
Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery.
|
0920
|
Other Diagnostic Services - General Classification
|
RC
|
- Myocardial infarction
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA), right coronary artery = RCA. ICD-10 I21-I22 ICD-9 410 DiseasesDB 8664 MedlinePlus 000195 eMedicine med/1567 emerg/327 ped/2520 MeSH D009203
Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).
|
0195
|
Subacute
|
RC
|
- Myocardial infarction
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA), right coronary artery = RCA. ICD-10 I21-I22 ICD-9 410 DiseasesDB 8664 MedlinePlus 000195 eMedicine med/1567 emerg/327 ped/2520 MeSH D009203
Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).
|
99213
|
Telehealth visit INT
|
HCPCS
|
When the coder locations the code J02.nine on the healthcare claim, it tells the insurance company that the patient was noticed simply because they had been complaining of a sore throat. • CPT, or treatment, codes, inform the insurance organization what techniques had been carried out on the affected person on the day that they have been witnessed. For example, the code 99213 is employed to signify a standard workplace visit. When the coder contains the code 99213 on the assert, it tells the insurance business that the health-related service provider carried out a mid-variety workplace go to. • HCPCS, or supply codes, are used to represent all of the other miscellaneous solutions or provides provided to a patient on the working day they have been seen.
|
99213
|
Telehealth visit INT
|
HCPCS
|
• CPT, or treatment, codes, inform the insurance organization what techniques had been carried out on the affected person on the day that they have been witnessed. For example, the code 99213 is employed to signify a standard workplace visit. When the coder contains the code 99213 on the assert, it tells the insurance business that the health-related service provider carried out a mid-variety workplace go to. • HCPCS, or supply codes, are used to represent all of the other miscellaneous solutions or provides provided to a patient on the working day they have been seen. These codes are not always integrated on a assert kind simply because they contain materials or other solutions that are not incorporated in the CPT ebook, this sort of as ambulance transportation or tough health-related products.
|
99213
|
Telehealth visit INT
|
HCPCS
|
For example, the code 99213 is employed to signify a standard workplace visit. When the coder contains the code 99213 on the assert, it tells the insurance business that the health-related service provider carried out a mid-variety workplace go to. • HCPCS, or supply codes, are used to represent all of the other miscellaneous solutions or provides provided to a patient on the working day they have been seen. These codes are not always integrated on a assert kind simply because they contain materials or other solutions that are not incorporated in the CPT ebook, this sort of as ambulance transportation or tough health-related products. Healthcare vendors only monthly bill for CPT and HCPCS codes because they symbolize genuine providers and materials provided to the patient.
|
99213
|
Telehealth visit INT
|
HCPCS
|
When the coder contains the code 99213 on the assert, it tells the insurance business that the health-related service provider carried out a mid-variety workplace go to. • HCPCS, or supply codes, are used to represent all of the other miscellaneous solutions or provides provided to a patient on the working day they have been seen. These codes are not always integrated on a assert kind simply because they contain materials or other solutions that are not incorporated in the CPT ebook, this sort of as ambulance transportation or tough health-related products. Healthcare vendors only monthly bill for CPT and HCPCS codes because they symbolize genuine providers and materials provided to the patient. Each and every code is presented an personal charge, and is independently reimbursed by the insurance policy business.
|
1745
|
Thoracoscopic robotic assisted procedure
|
ICD
|
PMID 17141745. - World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation.
|
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 HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery.
|
43644
|
PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
S2083
|
PR ADJUSTMENT GASTRIC BAND
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
1999
|
ANESTHESIOLOGY GROUP
|
CPT
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
S2082
|
Lap adjustable gastric band
|
CPT
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
43659
|
HC UNLISTED LAPAROSCOPE PROC STOM
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
43633
|
Removal of stomach partial
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
43847
|
PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
43845
|
PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
43846
|
PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/<
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
43645
|
PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
S2085
|
Laparoscop gastric bypass
|
CPT
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
43848
|
Revision gastroplasty
|
HCPCS
|
POLICY HISTORY1/1993: Approved by Medical Policy Advisory Committee (MPAC)
11/1998: Medical Management of Obesity approved by MPAC
8/1999: Revisions to Surgery for Morbid Obesity approved by MPAC
1/2000: Medical Management of Obesity and Surgery for Morbid Obesity policies merged; interim policy revisions
2/2000: Interim policy revisions approved by MPAC
3/22/2000: See POLICY EXCEPTIONS for First Chemical
9/14/2000: Long limb (>100 cm) gastric bypass procedures are investigational and not covered. See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered.
|
43644
|
PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
S2083
|
PR ADJUSTMENT GASTRIC BAND
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
S2082
|
Lap adjustable gastric band
|
CPT
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
43659
|
HC UNLISTED LAPAROSCOPE PROC STOM
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
43633
|
Removal of stomach partial
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
43847
|
PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
43845
|
PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
43846
|
PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/<
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
43645
|
PR LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
S2085
|
Laparoscop gastric bypass
|
CPT
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
43848
|
Revision gastroplasty
|
HCPCS
|
See Surgical Management
1/9/2001: See POLICY EXCEPTIONS for BancorpSouth
2/2/2001: See POLICY EXCEPTIONS for Mississippi Power
11/29/2001: See POLICY EXCEPTIONS for Ryder System, Incorporation
1/7/2002: Singing River (self insured group) will cover all 5 surgical procedures for morbid obesity added to POLICY EXCEPTIONS. 2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity."
|
43644
|
PR LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM
|
HCPCS
|
2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated.
|
S2083
|
PR ADJUSTMENT GASTRIC BAND
|
HCPCS
|
2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated.
|
S2082
|
Lap adjustable gastric band
|
CPT
|
2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated.
|
43659
|
HC UNLISTED LAPAROSCOPE PROC STOM
|
HCPCS
|
2/1/2002: Mid-Delta Home Health added to POLICY EXCEPTIONS
2/13/2002: Investigational definition added
3/8/2002: Prior authorization deleted. Policy Exceptions are Group Specific, Renal Care Group added to POLICY EXCEPTIONS
5/1/2002: Type of Service and Place of Service deleted
6/3/2002: CPT code 43848 moved to covered
10/8/2002: Laparoscopic and other investigational procedures added to Surgical Management, Chevron/Texaco POLICY EXCEPTIONS added, Sources updated, Code Reference section updated
3/3/2003: CPT code 43659 updated
9/22/2003: FEP Policy Exception added, Biliopancreatic Bypass with Duodenal Switch added to CPT 43659, Biliopancreatic Bypass moved from CPT 43659 to CPT 43857
11/2003: Reviewed by MPAC, no changes
2/27/2004: Code Reference section updated
4/22/2004: CPT code 43633 added
8/18/2004: Policy Exception for Singing River “Note: Singing River (self-insured group) effective 9/1/2004, there will be a $10,000 per lifetime limit on surgical treatment for morbid obesity and any resulting complications of such surgery. All surgical procedures must be prior authorized and all BCBSMS policy requirements under 'Surgical Management' section in effect at the time of the surgical procedure must be satisfied for coverage.” added
10/21/2004: Metropolitan Life Height and Weight Tables added
11/18/2004: Reviewed by MPAC, no changes, Sources updated
1/5/2005: Short limb < 100 cm changed to 150 cm or less, Code Reference section updated, CPT 43644 added covered codes, CPT 43659 note added, CPT 43846 description revised, ICD-9 procedure code 44.68, 44.96 added covered codes, HCPCS S2085 deletion date of 12/31/2004 added, CPT 43645, 43845 added non-covered codes, CPT 43659 note added non-covered codes, CPT 43847 description revised and note added, ICD-9 procedure code 44.93, 44.94, 44.95, 44.97, 44.98, 44.99, 97.86 added non-covered codes, HCPCS S2082, S2083 added non-covered codes
2/8/2005: Singing River clarification "Only the surgical procedures listed under 'Surgical Management' section as identified by 'eligible for coverage' are covered. Those procedures/surgeries that are listed as 'investigational' are not covered regardless of medical necessity." added
11/8/2005: Code Reference Section updated, ICD9 diagnosis codes V85.23-V85.25, V85.30-V85.39, V85.4 added
2/2/2006: Policy Exception section updated, prior authorization requirement was removed from BancorpSouth
3/15/2006: Coding updated.
|
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