NCD for Medicine: Human Chorionic Gonadotropin(190.27)
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1 Codes from CPSI Code Listing that Support Medical Necessity **Choose a corresponding ICD9 code from the corresponding group that the CPT code resides in when selecting a code that supports Medical Necessity. CPT CHORIONIC GONADOTROPIN TEST Resolution Code 1: ICD-9 Codes Covered by Medicare MAL NEO RETROPERITONEUM MAL NEO PERITONEUM NEC MAL NEO ANT MEDIASTINUM MAL NEO POST MEDIASTINUM MAL NEO MEDIASTINUM NEC MAL NEO MEDIASTINUM NOS MALIGNANT NEOPL PLACENTA MALIGN NEOPL OVARY MAL NEO ADNEXA NEC MAL NEO UNDESCEND TESTIS MALIG NEO TESTIS NEC MALIGN NEO PINEAL GLAND SEC MAL NEO MEDIASTINUM SEC MAL NEO PERITONEUM SECOND MALIG NEO OVARY SECOND MALIG NEO GENITAL UNC BEHAV NEO PLACENTA NEOPLASM RELATED PAIN ACUTE CHRON NONINFLAM DIS VAGINA NEC FEM GENITAL SYMPTOMS NOS HYDATIDIFORM MOLE OTH ABN PROD CONCEPTION MISSED ABORTION See Diagnosis Table Display for Description See Diagnosis Table Display for Description See Diagnosis Table Display for Description See Diagnosis Table Display for Description 1
2 Resolution Code 1: ICD-9 Codes Covered by Medicare See Diagnosis Table Display for Description See Diagnosis Table Display for Description OTHER ABNORMAL TUMOR MARKERS V HX OF GI MALIGNANCY NEC V HX-INTRATHORACIC MAL NEC V HX OF OVARIAN MALIGNANCY V HX-TESTICULAR MALIGNANCY V220-V221 - See Diagnosis Table Display for Description See Diagnosis Table Display for Description V PER HIST CONT-EXP POT HAZ BDY FLUID V161 - FM HX-TRACH BRONCHOG MAL V162 - FAM HX-INTRATHORACIC MAL V FAM HIST OF MALIG NEOPLASM GENITAL V Description Not Found V FAM HIS - MAL NEO - KIDNEY V FAMILY HISTORY OF MALIGNANT NEOPLAS V FAM HIS - AL NEO - OTH URIN ORG V166 - FAMILY HX-LEUKEMIA V167 - FAM HX-LYMPH NEOPLAS NEC V168 - FAMILY HX-MALIGNANCY NEC V169 - FAMILY HX-MALIGNANCY NOS V170-V See Diagnosis Table Display for Description V FAMILY HISTORY OF SUDDEN CARDIAC DE V FAMILY HISTORY OF OTHER CARDIOVASCU V180 - FAM HX-DIABETES MELLITUS V FAMILY HISTORY OF MULTIPLE ENDOCRIN V FAMILY HISTORY OF OTHER ENDOCRINE A V182 - FAMILY HX-ANEMIA V183 - FAM HX-BLOOD DISORD NEC V184 - FAM HX-MENTAL RETARDAT V FAMILY HISTORY, COLONIC POLYPS 2
3 V FAMILY HISTORY OTHER DIGESTIVE DISO V FAM HIS - POLY KIDNEY V FAM HIS - OTH KIDNEY DISEASES V187 - FAMILY HX-GU DISEASE NEC V188 - FM HX-INFECT PARASIT DIS V189 - FAMILY HX OF GENETIC DISEASE CARRIE V190 - FAMILY HX-BLINDNESS V191 - FAMILY HX-EYE DISORD NEC V192 - FAMILY HX-DEAFNESS V193 - FAMILY HX-EAR DISORD NEC V194 - FAMILY HX-SKIN CONDITION V195 - FAM HX-CONGEN ANOMALIES V196 - FAMILY HX-ALLERGIC DIS V197 - CONSANGUINITY V198 - FAMILY HX-CONDITION NEC V200 - FOUNDLING HEALTH CARE V201 - CARE OF HEALTHY CHLD NEC V202 - ROUTIN CHILD HEALTH EXAM V2031-V See Diagnosis Table Display for Description V280 - SCREENING-CHROMOSOM ANOM V281 - SCREEN-ALPHAFETOPROTEIN V282 - SCREEN BY AMNIOCENT NEC V283 - ENCOUNTER FOR ROUTINE SCREENING MAL V284 - SCREEN-FETAL RETARDATION V285 - SCREEN-ISOIMMUNIZATION V286 - ANTENATAL SCREEN FOR STREPTCOCCUS B V287 - Description Not Found V288 - ANTENATAL SCREENING NEC V289 - ANTENATAL SCREENING NOS V500-V509 - See Diagnosis Table Display for Description V532 - ADJUSTMENT HEARING AID V600 - LACK OF HOUSING V601 - INADEQUATE HOUSING 3
4 V602 - ECONOMIC PROBLEM V603 - PERSON LIVING ALONE V604 - NO FAMILY ABLE TO CARE V605 - HOLIDAY RELIEF CARE V606 - PERSON IN RESIDENT INST V FOSTER CARE STATUS V HOUSING-ECONO CIRCUM NEC V609 - HOUSING ECONO CIRCUM NOS V620 - UNEMPLOYMENT V621 - ADVERSE EFF-WORK ENVIRON V650 - HEALTHY PERSON W SICK V PED PREBIRTH VISIT EXPECT PARENTS V OTHER PERSON CONSULT ON BEHALF OTHE V680-V689 - See Diagnosis Table Display for Description V700 - ROUTINE MEDICAL EXAM V701 - PSYCH EXAM-AUTHORITY REQ V702 - GEN PSYCHIATRIC EXAM NEC V703 - MED EXAM NEC-ADMIN PURP V704 - EXAM-MEDICOLEGAL REASONS V705 - HEALTH EXAM-GROUP SURVEY V706 - HEALTH EXAM-POP SURVEY V707 - EXAM OF PARTICIPANT IN CLNL TRIAL V708 - GENERAL MEDICAL EXAM NEC V709 - GENERAL MEDICAL EXAM NOS V730 - SCREENING-POLIOMYELITIS V731 - SCREENING FOR SMALLPOX V732 - SCREENING FOR MEASLES V733 - SCREENING FOR RUBELLA V734 - SCREENING-YELLOW FEVER V735 - SCREENING-ARBOVIRUS DIS V736 - SCREENING FOR TRACHOMA V SPECIAL SCREENING EXAM, HPV V7388-V See Diagnosis Table Display for Description 4
5 V7398-V See Diagnosis Table Display for Description V740 - SCREENING FOR CHOLERA V741 - SCREENING-PULMONARY TB V742 - SCREENING FOR LEPROSY V743 - SCREENING FOR DIPHTHERIA V744 - SCREEN-BACT CONJUNCTIVIT V745 - SCREEN FOR VENERAL DIS V746 - SCREENING FOR YAWS V747 - Description Not Found V748 - SCREEN-BACTERIAL DIS NEC V749 - SCREEN-BACTERIAL DIS NOS V750 - SCREEN-RICKETTSIAL DIS V751 - SCREENING FOR MALARIA V752 - SCREEN FOR LEISHMANIASIS V753 - SCREEN-TRYPANOSOMIASIS V754 - SCREEN-MYCOTIC INFECT V755 - SCREEN-SCHISTOSOMIASIS V756 - SCREEN FOR FILARIASIS V757 - SCREEN FOR HELMINTHIASIS V758 - SCREEN-PARASITIC DIS NEC V759 - SCREEN FOR INFEC DIS NOS V760 - SCREEN MAL NEOP-RESP ORG V763 - SCREEN MAL NEOP-BLADDER V7642-V See Diagnosis Table Display for Description V7645-V See Diagnosis Table Display for Description V SPEC SCREEN FOR MALIG OTHER SITES V SPEC SCREEN FOR MALIG NEOP INTESTIN V SPEC SCREEN FOR MALIG NEOP SM INTES V SPEC SCREEN FOR MALIG NEOP NERV SYS V SPEC SCREEN FOR OTHER MALIG NEOPLAS V769 - SCREEN-NEOPLASM NOS V770 - SCREEN-THYROID DISORDER V772-V See Diagnosis Table Display for Description 5
6 V780-V See Diagnosis Table Display for Description V790-V See Diagnosis Table Display for Description V SCREEN-TRAUMATIC BRAIN INJURY V SCREEN-NEURO CONDITION V801 - SCREENING FOR GLAUCOMA V802 - SCREENING-EYE COND NEC V803 - SCREENING FOR EAR DIS V813 - SCREEN-BRONCH EMPHYSEMA V814 - SCREEN-RESPIR COND NEC V815 - SCREEN FOR NEPHROPATHY V816 - SCREEN FOR GU COND NEC V820 - SCREEN FOR SKIN COND V821 - SCREEN-RHEUMATOID ARTHR V822 - SCREEN-RHEUMAT DIS NEC V823 - SCREEN-CONG HIP DISLOCAT V824 - MAT POSTNATAL SCRN CHROMO ANOMAL V825 - SCREEN-CONTAMINATION NEC V826 - MULTIPHASIC SCREENING V SCREENING OF GENETIC DISEASE STATUS V OTHER GENETIC SCREENING V SPECIAL SCREENING FOR OSTEOPOROSIS V SPECIAL SCREEN OTHER SPECIFIED COND V829 - SCREEN FOR CONDITION NOS 6
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