Experimental and investigational procedure codes

Size: px
Start display at page:

Download "Experimental and investigational procedure codes"

Transcription

1 Experimental and investigational procedure codes Following are updated experimental and investigational procedure codes and associated supporting policies effective January 1, Procedure codes 0001M 0002M 0003M 0004M 0008M 0019T 0042T 0054T 0055T 0057T 0058T 0071T 0072T 0075T 0076T 0085T 0100T 0101T 0102T 0106T 0107T 0108T Supporting policy LAB Serum Markers for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease LAB Serum Markers for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease LAB Serum Markers for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease GENE DNA-Based Testing for Adolescent Idiopathic Scoliosis GENE Gene Expression Profiling for Managing Breast Cancer Treatment SURG Extracorporeal Shock Wave Therapy for Orthopedic Conditions RAD Cerebral Perfusion Imaging Using Computed Tomography SURG Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedures of the Appendicular System SURG Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedures of the Appendicular System MED Cryopreservation of Oocytes or Ovarian Tissue MED Cryopreservation of Oocytes or Ovarian Tissue MED MRI Guided High Intensity Focused Ultrasound Ablation of Uterine Fibroids MED MRI Guided High Intensity Focused Ultrasound Ablation of Uterine Fibroids SURG Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty SURG Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty TRANS Laboratory Testing as an Aid in the Diagnosis of Heart Transplant Rejection SURG Artificial Retinal Devices SURG Extracorporeal Shock Wave Therapy for Orthopedic Conditions SURG Extracorporeal Shock Wave Therapy for Orthopedic Conditions MED Quantitative Sensory Testing MED Quantitative Sensory Testing MED Quantitative Sensory Testing IAPEC April 2018

2 0109T 0110T 0163T 0165T 0169T 0171T 0172T 0182T 0190T 0195T 0196T 0200T 0201T 0202T 0205T 0206T 0207T 0219T 0220T 0221T 0222T 0232T 0233T 0249T 0253T 0263T 0264T 0265T 0266T 0267T 0268T 0269T 0270T 0271T 0272T 0273T MED Quantitative Sensory Testing MED Quantitative Sensory Testing SURG Cervical Artificial Intervertebral Discs SURG Cervical Artificial Intervertebral Discs SURG Convection-Enhanced Delivery of Therapeutic Agents to the Brain SURG Implanted Devices for Spinal Stenosis SURG Implanted Devices for Spinal Stenosis RAD Brachytherapy for Oncologic Indications RAD Intraocular Epiretinal Brachytherapy SURG Axial Lumbar Interbody Fusion SURG Axial Lumbar Interbody Fusion SURG Percutaneous Vertebroplasty, Kyphoplasty and Sacroplasty SURG Percutaneous Vertebroplasty, Kyphoplasty and Sacroplasty SURG Implanted Devices for Spinal Stenosis RAD Near-Infrared Coronary Imaging and Near-Infrared Intravascular Ultrasound Coronary Imaging MED Computer Analysis and Probability Assessment of Electrocardiographic-Derived Data MED Automated Evacuation of Meibomian Gland SURG Facet Joint Allograft Implants for Facet Disease SURG Facet Joint Allograft Implants for Facet Disease SURG Facet Joint Allograft Implants for Facet Disease SURG Facet Joint Allograft Implants for Facet Disease MED Growth Factors, Silver-based Products and Autologous Tissues for Wound Treatment and Soft Tissue Grafting MED Noninvasive Measurement of Advanced Glycation End products (AGEs) in the Skin SURG Doppler-Guided Transanal Hemorrhoidal Deaterialization SURG Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir) TRANS Stem Cell Therapy for Peripheral Vascular Disease TRANS Stem Cell Therapy for Peripheral Vascular Disease TRANS Stem Cell Therapy for Peripheral Vascular Disease SURG Carotid Sinus Baroreceptor Stimulation Devices SURG Carotid Sinus Baroreceptor Stimulation Devices SURG Carotid Sinus Baroreceptor Stimulation Devices SURG Carotid Sinus Baroreceptor Stimulation Devices SURG Carotid Sinus Baroreceptor Stimulation Devices SURG Carotid Sinus Baroreceptor Stimulation Devices SURG Carotid Sinus Baroreceptor Stimulation Devices SURG Carotid Sinus Baroreceptor Stimulation Devices Page 2 of 16

3 0274T 0275T 0281T 0282T 0283T 0284T 0285T 0288T 0291T 0292T 0293T 0294T 0301T 0302T 0303T 0304T 0305T 0306T 0307T 0309T 0312T 0313T 0314T 0315T 0316T 0317T 0328T 0329T 0330T 0331T 0332T 0335T 0336T SURG Percutaneous and Endoscopic Spinal Surgery SURG Percutaneous and Endoscopic Spinal Surgery SURG Transcatheter Closure of Patent Foramen Ovale and Left Atrial Appendage for Stroke Prevention SURG Implanted (Epidural and Subcutaneous) Spinal Cord Stimulators (SCS) SURG Implanted (Epidural and Subcutaneous) Spinal Cord Stimulators (SCS) SURG Implanted (Epidural and Subcutaneous) Spinal Cord Stimulators (SCS) SURG Implanted (Epidural and Subcutaneous) Spinal Cord Stimulators (SCS) SURG Transanal Radiofrequency Treatment of Fecal Incontinence RAD Intravascular Optical Coherence Tomography (OCT) RAD Intravascular Optical Coherence Tomography (OCT) SURG Implantable Left Atrial Hemodynamic (LAH) Monitor SURG Implantable Left Atrial Hemodynamic (LAH) Monitor SURG Focused Microwave Therotherapy for Breast Cancer MED Intracardiac Ischemia Monitoring MED Intracardiac Ischemia Monitoring MED Intracardiac Ischemia Monitoring MED Intracardiac Ischemia Monitoring MED Intracardiac Ischemia Monitoring MED Intracardiac Ischemia Monitoring SURG Axial Lumbar Interbody Fusion SURG Bariatric Surgery and Other Treatments for Clinically Severe Obesity SURG Bariatric Surgery and Other Treatments for Clinically Severe Obesity SURG Bariatric Surgery and Other Treatments for Clinically Severe Obesity SURG Bariatric Surgery and Other Treatments for Clinically Severe Obesity SURG Bariatric Surgery and Other Treatments for Clinically Severe Obesity SURG Bariatric Surgery and Other Treatments for Clinically Severe Obesity SURG Implantable Cardioverter-Defibrillator (ICD) MED Continuous Monitoring of Intraocular Pressure MED Automated Evacuation of Meibomian Gland RAD Myocardial Sympathetic Innervation Imaging with or without Single- Photon Emission Computed Tomography (SPECT) RAD Myocardial Sympathetic Innervation Imaging with or without Single- Photon Emission Computed Tomography (SPECT) SURG Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis SURG Uterine Fibroid Ablation: Laparoscopic or Percutaneous Image Guided Techniques Page 3 of 16

4 0338T 0339T 0340T 0342T 0345T 0347T 0348T 0349T 0350T SURG Radiofrequency Ablation of the Renal Sympathetic Nerves SURG Radiofrequency Ablation of the Renal Sympathetic Nerves SURG Cryosurgical Ablation of Solid Tumors Outside the Liver MED Therapeutic Apheresis SURG Transcatheter Heart Valve Procedures RAD Radiostereometric Analysis (RSA) RAD Radiostereometric Analysis (RSA) RAD Radiostereometric Analysis (RSA) RAD Radiostereometric Analysis (RSA) 0351T SURG Intraoperative Assessment of Surgical Margins During Breast- Conserving Surgery with Radiofrequency Spectroscopy or Optical Coherence Tomography 0352T SURG Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery with Radiofrequency Spectroscopy or Optical Coherence Tomography 0353T SURG Intraoperative Assessment of Surgical Margins During Breast- Conserving Surgery with Radiofrequency Spectroscopy or Optical Coherence Tomography 0354T SURG Intraoperative Assessment of Surgical Margins During Breast- Conserving Surgery with Radiofrequency Spectroscopy or Optical Coherence Tomography 0357T 0375T 0380T 0392T 0393T 0394T 0395T 0397T 0402T 0423T 0424T 0425T 0426T 0427T 0428T MED Cryopreservation of Oocytes or Ovarian Tissue SURG Cervical Artificial Intervertebral Discs CG-MED-47 Fundus Photography SURG Lower Esophageal Sphincter Augmentation Devices for the Treatment of Gastroesophageal Reflux Disease (GERD) SURG Lower Esophageal Sphincter Augmentation Devices for the Treatment of Gastroesophageal Reflux Disease (GERD) THER-RAD Brachytherapy for Oncologic Indications THER-RAD Brachytherapy for Oncologic Indications MED In-Vivo Analysis of Gastrointestinal Lesions MED Corneal Collagen Cross-Linking LAB Advanced Lipoprotein Testing Page 4 of 16

5 0429T 0430T 0431T 0432T 0433T 0434T 0435T 0436T 0438T SURG SpaceOAR System ANC Cosmetic and Reconstructive Services: Skin Related ANC Cosmetic and Reconstructive Services: Skin Related ANC Cosmetic and Reconstructive Services: Skin Related ANC Cosmetic and Reconstructive Services of the Head and Neck ANC Cosmetic and Reconstructive Services of the Head and Neck ANC Cosmetic and Reconstructive Services of the Head and Neck ANC Cosmetic and Reconstructive Services of the Head and Neck ANC Cosmetic and Reconstructive Services of the Trunk and Groin ANC Cosmetic and Reconstructive Services of the Head and Neck ANC Cosmetic and Reconstructive Services of the Trunk and Groin SURG Panniculectomy and Abdominoplasty MED Treatment of Hyperhidrosis MED Treatment of Hyperhidrosis MED Treatment of Hyperhidrosis SURG Cryosurgical Ablation of Solid Tumors Outside the Liver SURG Cryosurgical Ablation of Solid Tumors Outside the Liver SURG Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedures of the Appendicular System SURG Open Treatment of Rib Fracture(s) Requiring Internal Fixation SURG Open Treatment of Rib Fracture(s) Requiring Internal Fixation SURG Open Treatment of Rib Fracture(s) Requiring Internal Fixation SURG Intradiscal Annuloplasty Procedures (Percutaneous Intradiscal Electrothermal Therapy IDET, Percutaneous Intradiscal Radiofrequency Thermocoagulation PIRFT and Intradiscal Biacuplasty IDB) Page 5 of 16

6 22527 SURG Intradiscal Annuloplasty Procedures (Percutaneous Intradiscal Electrothermal Therapy IDET, Percutaneous Intradiscal Radiofrequency Thermocoagulation PIRFT and Intradiscal Biacuplasty IDB) SURG Axial Lumbar Interbody Fusion MED Manipulation Under Anesthesia of the Spine and Joints other than the Knee MED Manipulation Under Anesthesia of the Spine and Joints other than the Knee MED Manipulation Under Anesthesia of the Spine and Joints other than the Knee MED Manipulation Under Anesthesia of the Spine and Joints other than the Knee SURG Sacroiliac Joint Fusion MED Manipulation Under Anesthesia of the Spine and Joints other than the Knee SURG Treatment of Osteochondral Defects SURG Extracorporeal Shock Wave Therapy for Orthopedic Conditions SURG Balloon Sinus Ostial Dilation SURG Balloon Sinus Ostial Dilation SURG Balloon Sinus Ostial Dilation MED Electromagnetic Navigational Bronchoscopy SURG Endobronchial Valve Devices SURG Endobronchial Valve Devices SURG Endobronchial Valve Devices SURG Endobronchial Valve Devices SURG Bronchial Thermoplasty SURG Bronchial Thermoplasty SURG Transcatheter Heart Valve Procedures SURG Transcatheter Heart Valve Procedures SURG Partial Left Ventriculectomy TRANS Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts) TRANS Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts) TRANS Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts) TRANS Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts) SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac Page 6 of 16

7 34842 SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac SURG Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac SURG Treatment of Varicose Veins (Lower Extremities), ANC Cosmetic and Reconstructive Services: Skin Related SURG Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea MED In-Vivo Analysis of Gastrointestinal Lesions SURG Transendoscopic Therapy for Gastroesophageal Reflux Disease and Dysphagia MED In-Vivo Analysis of Gastrointestinal Lesions SURG Transendoscopic Therapy for Gastroesophageal Reflux Disease SURG Artificial Anal Sphincter for the Treatment of Severe Fecal Incontinence SURG Surgical and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) and Other Genitourinary Conditions SURG Surgical and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) and Other Genitourinary Conditions SURG Surgical and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) and Other Genitourinary Conditions SURG Treatments for Urinary Incontinence SURG Prostate Saturation Biopsy SURG Carotid, Vertebral and Intracranial Artery Angioplasty with or without Stent Placement SURG Carotid, Vertebral and Intracranial Artery Angioplasty with or without Stent Placement SURG Carotid, Vertebral and Intracranial Artery Angioplasty with or without Stent Placement Page 7 of 16

8 61642 SURG Carotid, Vertebral and Intracranial Artery Angioplasty with or without Stent Placement SURG Deep Brain Stimulation SURG Lysis of Epidural Adhesions SURG Lysis of Epidural Adhesions SURG Percutaneous and Endoscopic Spinal Surgery RAD Cervical and Thoracic Discography SURG Sacral Nerve Stimulation (SNS) and Percutaneous Tibial Nerve Stimulation (PTNS) for Urinary and Fecal Incontinence; Urinary Retention SURG Refractive Surgery SURG Refractive Surgery SURG Refractive Surgery SURG Viscocanalostomy and Canaloplasty SURG Viscocanalostomy and Canaloplasty ANC.0008 Cosmetic and Reconstructive Services of the Head and Neck RAD Cervical and Thoracic Discography RAD Computed Tomography to Detect Coronary Artery Calcification RAD Peripheral Bone Mineral Density Measurement RAD MRI of the Bone Marrow THER-RAD Neutron Beam Radiotherapy THER-RAD Neutron Beam Radiotherapy MED Hyperthermia for Cancer Therapy MED Hyperthermia for Cancer Therapy RAD Peripheral Bone Mineral Density Measurement RAD Single Photon Emission Computed Tomography (SPECT) Scans for Noncardiovascular Indications GENE Genotype Testing for Genetic Polymorphisms to Determine Drug- Metabolizer Status GENE Prothrombin G20210A (Factor II) Mutation Testing GENE Methylenetetrahydrofolate Reductase Mutation Testing GENE Gene-Based Tests for Screening, Detection and Management of Prostate Cancer GENE Genetic Testing for Inherited Peripheral Neuropathies GENE Genetic Testing for Inherited Peripheral Neuropathies GENE Genetic Testing for Inherited Peripheral Neuropathies GENE Genotype Testing for Genetic Polymorphisms to Determine Drug- Metabolizer Status GENE Genotype Testing for Genetic Polymorphisms to Determine Drug- Metabolizer Status GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases Page 8 of 16

9 81415 GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing for Colorectal Cancer Susceptibility GENE Genetic Testing for Colorectal Cancer Susceptibility GENE Genetic Testing for Cancer Susceptibility GENE Genetic Testing for Cancer Susceptibility GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing for Cancer Susceptibility, GENE Molecular Profiling for the Evaluation of Malignant Tumors, GENE Genetic Testing for Breast and/or Ovarian Cancer Syndrome, GENE Genetic Testing for Endocrine Gland Cancer Susceptibility, GENE Genetic Testing for TP53 Mutations (Li-Fraumeni Syndrome) GENE Genetic Testing for Cancer Susceptibility, GENE Molecular Profiling for the Evaluation of Malignant Tumors GENE Genetic Testing for Cancer Susceptibility, GENE Molecular Profiling for the Evaluation of Malignant Tumors, GENE Genetic Testing for Breast and/or Ovarian Cancer Syndrome, GENE Genetic Testing for Endocrine Gland Cancer Susceptibility, GENE Genetic Testing for TP53 Mutations (Li-Fraumeni Syndrome) GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Genetic Testing of an Individual's Genome for Inherited Diseases GENE Gene Expression Profiling for Cancers of Unknown Primary Site GENE Predictive Genetic Testing for Non-Malignant Diseases GENE Gene Expression Profiling for Colorectal Cancer LAB Analysis of Proteomic Patterns GENE Gene Expression Profiling for Cancers of Unknown Primary Site LAB Advanced Lipoprotein Testing in Cardiac Disease Risk Assessment and Management LAB Advanced Lipoprotein Testing in Cardiac Disease Risk Assessment and Management LAB Advanced Lipoprotein Testing in Cardiac Disease Risk Assessment and Management LAB Advanced Lipoprotein Testing in Cardiac Disease Risk Assessment and Management Page 9 of 16

10 83701 LAB Advanced Lipoprotein Testing in Cardiac Disease Risk Assessment and Management LAB Advanced Lipoprotein Testing in Cardiac Disease Risk Assessment and Management LAB Rupture of Membranes (ROM) Testing in Pregnancy LAB Selected Blood, Serum and Cellular Allergy and Toxicity Tests LAB Detection of Circulating Tumor Cells in the Blood as a Prognostic Factor for Cancer LAB Detection of Circulating Tumor Cells in the Blood as a Prognostic Factor for Cancer LAB Selected Blood, Serum and Cellular Allergy and Toxicity Tests LAB Immune Cell Function Assay MED In-Vivo Analysis of Gastrointestinal Lesions ADMIN Immunizations RAD Wireless Capsule Endoscopy for Esophageal and Small Bowel Imaging and the Patency Capsule MED Wireless Capsule for the Evaluation of Suspected Gastric and Intestinal Motility Disorders MED Anterior Segment Optical Coherence Tomography MED Microvolt T-Wave Alternans MED Bioimpedance Spectroscopy Devices for the Detection and Management of Lymphedema MED Selected Sleep Testing Services MED Automated Nerve Conduction Testing MED Autonomic Testing MED Autonomic Testing MED Autonomic Testing MED Autonomic Testing MED Autonomic Testing MED Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) MED Low-Frequency Ultrasound Therapy for Wound Management A4575 A4638 A9272 A9507 A9527 A9584 A9586 MED Hyperbaric Oxygen Therapy (Systemic/Topical) DME Transtympanic Micropressure for the Treatment of Ménière s Disease DME Vacuum-Assisted Wound Therapy in the Outpatient Setting RAD Single Photon Emission Computed Tomography (SPECT) Scans for Noncardiovascular Indications THER-RAD Brachytherapy for Oncologic Indications RAD Single Photon Emission-Computed Tomography (SPECT) Scans for Noncardiovascular Indications RAD Positron Emission Tomography (PET) and PET/CT Fusion Page 10 of 16

11 A9599 C1821 C1841 C2624 C9349 C9352 C9353 C9354 C9355 C9356 C9358 C9360 C9361 C9364 C9458 C9459 C9461 C9472 C9739 C9740 C9741 E0218 E0236 E0481 E0485 E0617 E0637 E0638 RAD Positron Emission Tomography (PET) and PET/CT Fusion SURG Implanted Devices for Spinal Stenosis SURG Artificial Retinal Devices MED Outpatient Cardiac Hemodynamic Monitoring Using a Wireless Sensor for Heart Failure Management RAD Positron Emission Tomography (PET) and PET/CT Fusion RAD Positron Emission Tomography (PET) and PET/CT Fusion RAD Positron Emission Tomography (PET) and PET/CT Fusion MED Melanoma Vaccines SURG Surgical and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) and Other Genitourinary Conditions SURG Surgical and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) and Other Genitourinary Conditions MED Outpatient Cardiac Hemodynamic Monitoring Using a Wireless Sensor for Heart Failure Management DME Cooling Devices and Combined Cooling/Heating Devices DME Cooling Devices and Combined Cooling/Heating Devices DME Oscillatory Devices for Airway Clearance including High Frequency Chest Compression and Intrapulmonary Percussive Ventilation (IPV) DME Prefabricated Oral Appliance for the Treatment of Obstructive Sleep Apnea DME Automated External Defibrillators for Home Use DME Standing Frames DME Standing Frames Page 11 of 16

12 E0641 E0642 E0762 E0764 E0770 E1801 E1806 E1811 E1816 E1818 E1821 E1831 E1841 E2120 E2230 E2301 G0130 G0219 G0252 G0255 G0341 G0342 G0343 DME Standing Frames DME Standing Frames DME Electrical Stimulation as a Treatment for Pain and Related Conditions: Surface and Percutaneous Devices DME Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES) DME Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES) DME Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices DME Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices DME Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices DME Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices DME Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices DME Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices DME Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices DME Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices DME Transtympanic Micropressure for the Treatment of Ménière s Disease DME Standing Frames DME Standing Frames RAD Peripheral Bone Mineral Density Measurement RAD Positron Emission Tomography (PET) and PET/CT Fusion RAD Positron Emission Tomography (PET) and PET/CT Fusion MED Quantitative Sensory Testing TRANS Autologous and Allogeneic Pancreatic Islet Cell Transplantation TRANS Autologous and Allogeneic Pancreatic Islet Cell Transplantation TRANS Autologous and Allogeneic Pancreatic Islet Cell Transplantation G0428 G0460 MED Growth Factors, Silver-based Products and Autologous Tissues for Wound Treatment and Soft Tissue Grafting G9143 GENE Genotype Testing for Genetic Polymorphisms to Determine Drug- Metabolizer Status G9147 MED Hepatic Activation Therapy L5973 L6026 OR PR Microprocessor Controlled Lower Limb Prosthesis OR PR.0004 Myoelectric Upper Extremity Prosthetic Devices Page 12 of 16

13 L6715 L8607 M0075 M0076 Q4102 Q4103 Q4105 Q4107 Q4108 Q4110 Q4111 Q4112 Q4113 Q4114 Q4117 Q4118 Q4119 Q4120 Q4122 Q4123 Q4124 Q4125 Q4126 Q4127 OR PR Partial-Hand Myoelectric Prosthesis MED Adoptive Immunotherapy and Cellular Therapy MED Prolotherapy for Joint and Ligamentous Conditions Page 13 of 16

14 Q4129 Q4130 Q4132 Q4133 Q4134 Q4135 Q4136 Q4137 Q4138 Q4139 Q4140 Q4141 Q4142 Q4143 Q4145 Q4146 Q4147 Q4148 Q4149 Q4150 Q4151 Q4152 Q4153 Page 14 of 16

15 Q4154 Q4155 Q4156 Q4157 Q4158 Q4159 Q4160 Q4161 Q4162 Q4163 Q4164 Q4165 S0596 S1090 S2102 S2103 S2107 S2117 S2230 S2300 S2348 S2400 S3721 S3800 S3852 S3861 S3865 SURG Refractive Surgery SURG Devices for Maintaining Sinus Ostial Patency Following Sinus Surgery TRANS Autologous and Allogeneic Pancreatic Islet Cell Transplantation TRANS Cell Transplantation (Mesencephalic, Adrenal-Brain and Fetal Xenograft) MED Adoptive Immunotherapy and Cellular Therapy SURG Subtalar Arthroereisis SURG Implantable Middle Ear Hearing Aids SURG Electrothermal Shrinkage of Joint Capsules, Ligaments, and Tendons SURG Percutaneous and Endoscopic Spinal Surgery SURG Fetal Surgery for Prenatally Diagnosed Malformations GENE Gene-Based Tests for Screening, Detection and Management of Prostate Cancer GENE Diagnostic Genetic Testing of a Potentially Affected Individual (Adult or Child) GENE Genetic Testing and Biochemical Markers for the Diagnosis of Alzheimer's Disease GENE Cardiac Ion Channel Genetic Testing GENE Genetic Testing for Diagnosis and Management of Hereditary Cardiomyopathies (including ARVD/C) Page 15 of 16

16 S3890 S8040 S8080 S8085 S8130 S8131 S8930 S8940 S9024 S9055 S9056 S9090 V2787 V2788 V5095 GENE Analysis of Fecal DNA for Colorectal Cancer Screening and Surveillance MED Selected Sleep Testing Services RAD Single Photon Emission Computed Tomography (SPECT) Scans for Noncardiovascular Indications RAD PET Scanning Using Gamma Cameras DME Electrical Stimulation as a Treatment for Pain and Related Conditions: Surface and Percutaneous Devices DME Electrical Stimulation as a Treatment for Pain and Related Conditions: Surface and Percutaneous Devices DME Electrical Stimulation as a Treatment for Pain and Related Conditions: Surface and Percutaneous Devices REHAB Hippotherapy RAD Ultrasound for the Evaluation of Paranasal Sinuses MED Growth Factors, Silver-based Products and Autologous Tissues for Wound Treatment and Soft Tissue Grafting MED Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State SURG Mechanized Spinal Distraction Therapy for Low Back Pain (VAX-D Therapy, DRS System, Accu-Spina System IDD Therapy) SURG Presbyopia and Astigmatism-Correcting Intraocular Lenses SURG Presbyopia and Astigmatism-Correcting Intraocular Lenses SURG Implantable Middle Ear Hearing Aids Page 16 of 16

OH, IN, KY, MO: Lumenos Health Savings Account, Lumenos Health Reimbursement Account, Lumenos Health Incentive Account

OH, IN, KY, MO: Lumenos Health Savings Account, Lumenos Health Reimbursement Account, Lumenos Health Incentive Account Anthem Blue Cross and Blue Shield Central Region 2012 (Effective 3/5/2012) Consumer Directed Health Plans Pre-Certification List for Indiana, Kentucky Missouri, Ohio and Wisconsin OH, IN, KY, MO: Lumenos

More information

AIM Specialty Health

AIM Specialty Health GA Standard Preapproval CODE List (06/01/18) Eligibility and benefits Eligibility and benefits can be verified by accessing the BCBSGa/BCBSHP web site bcbsga.com or by calling the number on the back of

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: September 1, 2016 The following Medical Protocol update includes information on protocols that have undergone a review over the last several

More information

sad EFFECTIVE DATE: POLICY LAST UPDATED:

sad EFFECTIVE DATE: POLICY LAST UPDATED: Medical Coverage Policy Prior Authorization via Web-Based Tool for Procedures sad EFFECTIVE DATE: 09 01 2015 POLICY LAST UPDATED: 12 18 2018 OVERVIEW This policy documents the prior authorization request

More information

Anthem Blue Cross and Blue Shield GA Standard Preapproval CODE List 4/1/2019

Anthem Blue Cross and Blue Shield GA Standard Preapproval CODE List 4/1/2019 Anthem Blue Cross and Blue Shield GA Standard Preapproval CODE List 4/1/2019 Eligibility and benefits: Eligibility and benefits can be verified by accessing the Anthem Blue Cross and Blue Shield web site

More information

Services Requiring Prior Authorization

Services Requiring Prior Authorization The table below outlines the services that require Prior Authorization (PA) for BlueChoice HealthPlan Medicaid members enrolled in the Healthy Connections program. The following list may not be all-inclusive,

More information

OH, IN, KY, MO: Lumenos Health Savings Account, Lumenos Health Reimbursement Account, Lumenos Health Incentive Account

OH, IN, KY, MO: Lumenos Health Savings Account, Lumenos Health Reimbursement Account, Lumenos Health Incentive Account Anthem Blue Cross and Blue Shield Central Region 2018 Consumer Directed Health Plans Pre- Certification List for Indiana, Kentucky Missouri, Ohio and Wisconsin OH, IN, KY, MO: Lumenos Health Savings Account,

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: June 1, 2010 The following clinical protocol update includes information on protocols that have had an annual review recently resulting in

More information

Services requiring prior authorization

Services requiring prior authorization Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect Services requiring prior authorization The table below outlines the services that require prior authorization (PA) for Anthem Blue

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: September 2, 2014 The following Medical Protocol update includes information on protocols that have undergone a review over the last several

More information

sad EFFECTIVE DATE: POLICY LAST UPDATED:

sad EFFECTIVE DATE: POLICY LAST UPDATED: Medical Coverage Policy Prior Authorization via Web-Based Tool for Procedures sad EFFECTIVE DATE: 09 01 2015 POLICY LAST UPDATED: 12 19 2017 OVERVIEW This policy documents the prior authorization request

More information

Services Requiring Prior Authorization Revised January 8, 2018

Services Requiring Prior Authorization Revised January 8, 2018 Services Requiring Prior Authorization Revised January 8, 2018 The information contained in this document outlines the services that require prior authorization from Advanced Medical Management, Inc. (AMM)

More information

sad EFFECTIVE DATE: POLICY LAST UPDATED:

sad EFFECTIVE DATE: POLICY LAST UPDATED: Medical Coverage Policy Prior Authorization via Web-Based Tool for Procedures sad EFFECTIVE DATE: 09 01 2015 POLICY LAST UPDATED: 12 19 2017 FOR INTERNAL USE ONLY: An RSS was requested to remove prior

More information

Chapter 4 Section 20.1

Chapter 4 Section 20.1 Surgery Chapter 4 Section 20.1 Issue Date: August 29, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) 1.0 CPT 1 PROCEDURE CODES 61000-61626, 61680-62264, 62268-62284, 62290-63048, 63055-64484, 64505-64595,

More information

Chapter 4 Section 20.1

Chapter 4 Section 20.1 Surgery Chapter 4 Section 20.1 Issue Date: August 29, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) Copyright: CPT only 2006 American Medical Association (or such other date of publication of CPT). All

More information

Anthem Blue Cross and Blue Shield Central Region 2018 Blue Products Pre-Certification List for Indiana, Kentucky, Missouri, Ohio and Wisconsin

Anthem Blue Cross and Blue Shield Central Region 2018 Blue Products Pre-Certification List for Indiana, Kentucky, Missouri, Ohio and Wisconsin Anthem Blue Cross and Blue Shield Central Region 2018 Blue Products Pre-Certification List for Indiana, Kentucky, Missouri, Ohio and Wisconsin OH/IN/KY Blue Products: Blue Priority SM (HMO), Blue Priority

More information

Services Requiring Prior Authorization Effective April 1, 2015

Services Requiring Prior Authorization Effective April 1, 2015 Services Requiring Prior Authorization Effective April 1, 2015 The information contained in this document outlines the services that require prior authorization from Advanced Medical Management, Inc. (AMM)

More information

Anthem Blue Cross and Blue Shield Central Region 2013 Blue Products Pre-Certification List for Indiana, Kentucky, Missouri, Ohio and Wisconsin

Anthem Blue Cross and Blue Shield Central Region 2013 Blue Products Pre-Certification List for Indiana, Kentucky, Missouri, Ohio and Wisconsin Anthem Blue Cross and Blue Shield Central Region 2013 Blue Products Pre-Certification List for Indiana, Kentucky, Missouri, Ohio and Wisconsin OH/IN/KY Blue Products: Blue Priority SM (HMO), Blue Priority

More information

Effective April 7, 2014 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST IMPORTANT

Effective April 7, 2014 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST IMPORTANT Effective April 7, 2014 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST The following services require clinical review preauthorization for commercial managed care products, Medicare,

More information

Medical Services Protocol Updates. Distribution Date: March 1, 2013

Medical Services Protocol Updates. Distribution Date: March 1, 2013 Protocol Medical Services Protocol Updates Distribution Date: March 1, 2013 The following Medical Protocol update includes information on Protocols that have recently undergone an annual review. The review

More information

CUSTOMIZATIONS TO MCKESSON INTERQUAL CRITERIA Issue Date: December 19, 2013 Original Date: May 1, 2013

CUSTOMIZATIONS TO MCKESSON INTERQUAL CRITERIA Issue Date: December 19, 2013 Original Date: May 1, 2013 CUSTOMIZATIONS TO MCKESSON INTERQUAL CRITERIA Issue Date: December 19, 2013 Original Date: May 1, 2013 NOTES: This document provides a high-level summary of customizations and modifications made to McKesson

More information

Chapter 4 Section 20.1

Chapter 4 Section 20.1 Surgery Chapter 4 Section 20.1 Issue Date: August 29, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) Copyright: CPT only 2006 American Medical Association (or such other date of publication of CPT). All

More information

Medical Policy New Technology Assessment and Non-Covered Services

Medical Policy New Technology Assessment and Non-Covered Services Medical Policy New Technology Assessment and Non-Covered Services Subject: New Technology Assessment and Non-Covered Services Background: Harvard Pilgrim Health Care (HPHC) does not cover services or technology

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: March 1, 2019 The following medical protocol updates include information on protocols that have undergone an annual review over the last several

More information

Oregon CPT Preapproval Grid

Oregon CPT Preapproval Grid Not Applicable Home Health Stays - For all Initial Certification and Recertification periods Notes: Initial Certification review required effective 1/1/12. Not Applicable Skilled Nursing Facility Stays

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: March 1, 2011 The following clinical protocol update includes information on protocols that have had an annual review recently resulting in

More information

Services Requiring Prior Authorization

Services Requiring Prior Authorization Serving Hoosier Healthwise and Healthy Indiana Plan The table below outlines the services that require prior authorization for Anthem s State Sponsored Plan members enrolled in the Indiana Hoosier Healthwise

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: December 1, 2018 The following medical protocol updates include information on protocols that have undergone an annual review over the last

More information

Medical policies update

Medical policies update On February 5, 2015, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following medical policies which are applicable to BlueChoice HealthPlan Medicaid. These medical policies

More information

Medical Policies and Clinical Utilization Management Guidelines update

Medical Policies and Clinical Utilization Management Guidelines update Medical Policies and Clinical Utilization Management Guidelines update Medical Policies update Summary: On July 26, 2018, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following

More information

April 4, 2016 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST

April 4, 2016 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST A nonprofit independent licensee of the BlueCross BlueShield Association April 4, 2016 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST The following services require clinical review

More information

CUSTOMIZATIONS TO MILLIMAN CARE GUIDELINES 15 th EDITION Original Date: March 3, 2011

CUSTOMIZATIONS TO MILLIMAN CARE GUIDELINES 15 th EDITION Original Date: March 3, 2011 Issue Date: July 19, 2011 CUSTOMIZATIONS TO MILLIMAN CARE GUIDELINES 15 th EDITION Original Date: March 3, 2011 NOTE: This document provides a high level summary of customizations and modifications made

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: June 1, 2017 The following update includes information on protocols that have undergone a review over the last several months, or an additional

More information

2016 MDwise Excel Network Hoosier Healthwise Medical Services that Require Prior Authorization

2016 MDwise Excel Network Hoosier Healthwise Medical Services that Require Prior Authorization 2016 MDwise Excel Network Hoosier Healthwise Medical Services that Require Prior Authorization Medical services that require Prior Authorization Type of Service Requires PA Coding All Out of Network services

More information

ต วอย าง AF เคร องม อทางการแพทย ท จะศ กษาท ม ความเส ยงน อยและความเส ยงมาก

ต วอย าง AF เคร องม อทางการแพทย ท จะศ กษาท ม ความเส ยงน อยและความเส ยงมาก EXAMPLES: ต วอย าง เคร องม อทางการแพทย ท จะศ กษาท ม ความเส ยงน อยและความเส ยงมาก ต วอย างเคร องม อทางการแพทย ท จะศ กษาท ม ความเส ยงน อย NON-SIGNIFICANT RISK DEVICE STUDIES Bio-stimulation Lasers for treatment

More information

Prior Authorization List Effective February 2, 2015

Prior Authorization List Effective February 2, 2015 Prior Authorization List Effective February 2, 2015 Prior authorization is required for the following services. Prior authorization is the responsibility of the provider ordering or rendering services

More information

Oregon CPT Preapproval Grid

Oregon CPT Preapproval Grid * The following grid only identifies items that require preapproval from. 11400-11471 Excision benign lesion 15820-15823 Blepharoplasty Notes: If Opthamologist requesting, pre-auth is not required 19316-19318

More information

! " " # $ " " # $ " % " # $ # $

!   # $   # $  %  # $ # $ ! " "#$ " "#$ " % "# $ #$ Skin Replacement Surgery Grafts 15040 Harvest of skin for cultured autograft 100 sq cm or less 15110 Epidermal autograft, trunk, arms, legs; first 100 sq cm or 1% of children

More information

POLICY AND PROCEDURE

POLICY AND PROCEDURE PAGE: Page 1 of 8 SCOPE: This policy applies to any provider furnishing services represented by Category III CPT codes. PURPOSE & IMPORTANT REMINDER: This policy is current at the time of publication.

More information

April 8, 2018 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST

April 8, 2018 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST A nonprofit independent licensee of the BlueCross BlueShield Association April 8, 2018 UTILIZATION MANAGEMENT STANDARD CLINICAL REVIEW PREAUTHORIZATION LIST The following services require clinical review

More information

2014 Deleted CPT Codes

2014 Deleted CPT Codes 2014 Deleted CPT Codes Surgery 13150 - Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or less 19102 - Biopsy of breast; percutaneous, needle core, using imaging guidance 19103 - Biopsy of breast;

More information

Jan 30, Dear Provider:

Jan 30, Dear Provider: Jan 30, 2015 Dear Provider: Kern Health Systems strives to provide quality and timely services to our members. Recently, KHS made changes to the services included on Prior Authorization Needed list. The

More information

UPMC University of Pittsburgh Medical Center. For Reference Only MEDICINE 2013

UPMC University of Pittsburgh Medical Center. For Reference Only MEDICINE 2013 Summary of Services and Availability (by location) Each location has sufficient space, equipment, staffing and financial resources in place or available in sufficient time as required to support each requested

More information

Table of Contents: Part 1 General principles. Section 1: Introduction. 1. Past, present and future of interventional physiatry 2.

Table of Contents: Part 1 General principles. Section 1: Introduction. 1. Past, present and future of interventional physiatry 2. Table of Contents: Part 1 General principles Section 1: Introduction 1. Past, present and future of interventional physiatry 2. Epidemiology Section 2: Spinal pain 3. Inflammatory basis of spinal pain

More information

The NCDs below are organized into separate tables by NCD Section. NCDs within each table are organized by NCD ID.

The NCDs below are organized into separate tables by NCD Section. NCDs within each table are organized by NCD ID. Three Penn Plaza East Newark, NJ 07105-2200 HorizonBlue.com NCDs and LCDs to Be Implemented Claims submitted for services provided on and after April 9, 2018 to Horizon BCBSNJ MA members will be processed

More information

1105 two (2) vertebrae... 1, add on per additional vertebra

1105 two (2) vertebrae... 1, add on per additional vertebra SPINE STAGE OPERATIONS Staged operations shall be paid at 100% for the first stage and 85% for the second stage. Where the second stage pays a higher fee 100% shall be paid and the first stage shall be

More information

MEDICAL POLICY New/Experimental Technology Procedure/Services

MEDICAL POLICY New/Experimental Technology Procedure/Services POLICY: PG0043 ORIGINAL EFFECTIVE: 07/05/05 LAST REVIEW: 01/25/18 MEDICAL POLICY New/Experimental Technology Procedure/Services GUIDELINES This policy does not certify benefits or authorization of benefits,

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: September 1, 2018 The following Medical Protocol updates includes information on protocols that have undergone an annual review over the last

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: December 1, 2016 The following Medical Protocol update includes information on protocols that have undergone a review over the last several

More information

22110 vertebral segment; cervical vertebral segment; thoracic vertebral segment; lumbar

22110 vertebral segment; cervical vertebral segment; thoracic vertebral segment; lumbar The following codes are authorized by Palladian Health for applicable product lines. Visit palladianhealth.com to request authorization and to access guidelines. Palladian Musculoskeletal Program Codes

More information

MEDICAL POLICY New/Experimental Technology Procedure/Services

MEDICAL POLICY New/Experimental Technology Procedure/Services POLICY: PG0043 ORIGINAL EFFECTIVE: 07/05/05 LAST REVIEW: 07/26/18 MEDICAL POLICY New/Experimental Technology Procedure/Services GUIDELINES This policy does not certify benefits or authorization of benefits,

More information

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac

More information

PET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET

PET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET Positron Emission Tomography (PET) When calling Anthem (1-800-533-1120) or using the Point of Care authorization system for a Health Service Review, the following clinical information may be needed to

More information

Arteriovenostomy for renal dialysis 39.27, 39.42

Arteriovenostomy for renal dialysis 39.27, 39.42 Surgery categories NHSN Surgery codes (Reference: NHSN Operative Procedure Category Mappings to ICD-9-CM Codes, October 2010 www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf) Operative aortic aneurysm

More information

Radiology Codes Requiring Authorization*

Radiology Codes Requiring Authorization* 70336 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) 70450 Computed tomography, head or brain; without contrast material 70460 Computed tomography, head or brain; with contrast material(s)

More information

Medical Pre-Authorization and Notification Requirements

Medical Pre-Authorization and Notification Requirements NOTICE CHANGE IN PRE-AUTHORIZATION PROCESS EFFECTIVE JANUARY 14, 2019 The Health Plan has entered into a partnership with Palladian Health to improve outcomes for musculoskeletal conditions and spine pain

More information

Sample page. Radiology. Cross Coder. Essential links from CPT codes to ICD-10-CM and HCPCS

Sample page. Radiology. Cross Coder. Essential links from CPT codes to ICD-10-CM and HCPCS Cross Coder 2018 Radiology Essential links from CPT codes to ICD-10-CM and HCPCS POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com. Contents Introduction...

More information

2014 PHYSICIAN PROCEDURE CODE CHANGES

2014 PHYSICIAN PROCEDURE CODE CHANGES Page 1 of 5 2014 PHYSICIAN PROCEDURE CODE CHANGES Effective for dates of service on or after 1/1/2014, refer to the New Codes listed below for billing. The discontinued codes are not valid for billing

More information

ADI Procedure Codes. August 2016 Revised April 2017 Page 1 of 7 ADI Procedure Codes

ADI Procedure Codes. August 2016 Revised April 2017 Page 1 of 7 ADI Procedure Codes Code Description 70450 CT Head without contrast 70460 CT Head with contrast 70470 CT Head with & without contrast 70480 CT Orbit, et al without contrast 70481 CT Orbit, et al with contrast 70482 CT Orbit,

More information

Provider Newsletter. Table of Contents. Reimbursement Policy: Improve member medication regimen. Page 2

Provider Newsletter. Table of Contents. Reimbursement Policy: Improve member medication regimen. Page 2 Provider Newsletter https://providers.amerigroup.com/ April 2018 Table of Contents Improve member medication regimen Page 2 Medical Policies and Clinical Utilization Management Guidelines updated Page

More information

Cigna - Prior Authorization Procedure List: Radiology & Cardiology

Cigna - Prior Authorization Procedure List: Radiology & Cardiology Cigna - Prior Authorization Procedure List: Radiology & Cardiology Category CPT Code CPT Code Description 93451 Right heart catheterization 93452 Left heart catheterization 93453 Combined right and left

More information

Description MRI, TMJ C T Head Without Contrast C T Head With Contrast C T Head Without & With Contrast

Description MRI, TMJ C T Head Without Contrast C T Head With Contrast C T Head Without & With Contrast s Requiring Prior Authorization for the Advanced Imaging 70336 MRI, TMJ 70450 C T Head Without Contrast 70460 C T Head With Contrast 70470 C T Head Without & With Contrast 70480 C T Orbit Without Contrast

More information

2012 CPT Changes Affecting Radiology REVISIONS

2012 CPT Changes Affecting Radiology REVISIONS 2012 CPT Changes Affecting Radiology REVISIONS 22520 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic 22521 lumbar 22522

More information

Prior Authorization List for Physician Alliance of the Rockies, UnitedHealthcare Medicare Advantage Effective April 1, 2018

Prior Authorization List for Physician Alliance of the Rockies, UnitedHealthcare Medicare Advantage Effective April 1, 2018 Prior List for Physician Alliance of MEDICAL MANAGEMENT CONTACT INFO- MONDAY - FRIDAY FROM 8:00 AM TO 5:00 PM - (720) 445-9404 *ALL REFERRALS TO SPECIALISTS REQUIRE PRIOR AUTHROIZATION* *ALL OUT OF NETWORK

More information

Medicare National Coverage Determinations Manual

Medicare National Coverage Determinations Manual Medicare National Coverage Determinations Manual Chapter 1, Part 1 (Sections 10 80.12) Coverage Determinations Transmittals for Chapter 1, Part 1 Table of Contents (Rev. 182, 05-22-15) Foreword - Purpose

More information

Episodes of Care Risk Adjustment

Episodes of Care Risk Adjustment Episodes of Care Risk Adjustment Episode Types Wave 1 Asthma Acute Exacerbation Perinatal Total Joint Replacement Wave 2 Acute Percutaneous Coronary Intervention COPD Acute Exacerbation Non-acute Percutaneous

More information

20983 Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue w

20983 Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue w The following Experimental and Investigational codes will no longer require medical necessity review. These changes are effective July 1, 2017 and subject to change. This update applies to all product

More information

Diagnostic & Therapeutic Cardiac Catheterization Coder 2017

Diagnostic & Therapeutic Cardiac Catheterization Coder 2017 Diagnostic & Therapeutic Cardiac Catheterization Coder 2017 Including peripheral and cardiovascular services and procedures Prepared and Published By: MedLearn Publishing A Division of Panacea Healthcare

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Orthop Clin N Am 38 (2007) 463 468 Index Note: Page numbers of article titles are in boldface type. A Andreas Vesalius, in history of spine pathology, 306 Anesthesia/anesthetics for PECD, 329 in minimally

More information

Chapter 16 Worksheet Code It

Chapter 16 Worksheet Code It Name: Class: Date: ID: A Chapter 16 Worksheet 3 2 1 Code It True/False Indicate whether the statement is true or false. 1. CT scans generate three-dimensional images. 2. An ultrasound produces images of

More information

HIP RADIOLOGY PROGRAM CODE LISTS

HIP RADIOLOGY PROGRAM CODE LISTS EFFECTIVE OCTOBER 1, 2012 70336 MAGNETIC RESONANCE IMAGING TMJ 70450 COMPUTED TOMOGRAPHY HEAD/BRAIN WITHOUT 70460 COMPUTED TOMOGRAPHY HEAD/BRAIN WITH 70470 COMPUTED TOMOGRAPHY HEAD/BRAIN WITHOUT AND WITH

More information

Back Pain Policies Summary

Back Pain Policies Summary Back Pain Policies Summary These policies are part of the wider project, Reviewing local health policies, which is reviewing and updating more than 100 policies, of which back pain are part of. This review

More information

PHA Annual High Claims Report 2018

PHA Annual High Claims Report 2018 24 October 2018 Medical device costs, increasing complexity and growing numbers of long hospital stays for mental health problems drive high health insurance claims PHA s Annual High Claims 2018 Report

More information

MDwise Community Health Network Hoosier Healthwise Medical Services that Require Prior Authorization

MDwise Community Health Network Hoosier Healthwise Medical Services that Require Prior Authorization MDwise Community Health Network Hoosier Healthwise Medical Services that Require Prior Authorization Medical services that require Prior Authorization Type of Service Requires PA Coding All Out of Network

More information

RADPrimer Curriculum Breast Topics Covered Basic Intermediate 225

RADPrimer Curriculum Breast Topics Covered Basic Intermediate 225 Breast Anatomy & Normal Variants 11 Breast Imaging Modalities 13 BI RADS Lexicon 3 Mammography: Masses 9 Mammography: Calcifications 17 Mammography: Additional Findings 8 Ultrasound Features 10 Ultrasound

More information

LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS. Please check with the LCC bookstore for the required texts for this class.

LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS. Please check with the LCC bookstore  for the required texts for this class. LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS SPECIAL NOTE: This brief syllabus is not intended to be a legal contract. A full syllabus will be distributed to students at the first class session. TEXT AND SUPPLEMENTARY

More information

Patient Name: Date of Birth:

Patient Name: Date of Birth: Patient Name: Date of Birth: Marital Status: Single Married Divorced Widowed Height: Referring Doctor: Weight: Primary Care Dr.: Preferred Pharmacy:(name/address) ALLERGIES: Do you have any drug allergies?

More information

Summary of Changes OPCS-4.5 to OPCS-4.6

Summary of Changes OPCS-4.5 to OPCS-4.6 Programme Sub Programme Technology Office Data Standards & Products/ Clinical Classifications Document Record ID Key NPFIT-SHR-SHI-0313.01 Acting Director, Data Standards & Products Nicholas Oughtibridge

More information

Cigna - Prior Authorization Procedure List: Radiology & Cardiology

Cigna - Prior Authorization Procedure List: Radiology & Cardiology Cigna - Prior Authorization Procedure List: Radiology & Cardiology Product Category CPT Code CPT Code Description Radiology MR 70336 MRI Temporomandibular Joint(s), (TMJ) Radiology CT 70450 CT Head or

More information

Peripheral and Cardiology Coder 2018

Peripheral and Cardiology Coder 2018 Peripheral and Cardiology Coder 2018 Cardiovascular Services and Procedures Prepared and Published By: MedLearn Publishing A Division of MedLearn Media, Inc. 445 Minnesota Street, Suite 514 St. Paul, MN

More information

ESCOME Pre-Course Outline (v1.09)

ESCOME Pre-Course Outline (v1.09) ESCOME Pre-Course Outline (v1.09) 1. Basics of Spinal Disorders Introduction to Spinal Surgery Spinal Anatomy Introduction to Vertebral Anatomical Concepts Anatomy and Function of Joints and Ligaments

More information

Chapter 4 Section 9.1

Chapter 4 Section 9.1 Surgery Chapter 4 Section 9.1 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) 1.0 CPT 1 PROCEDURE CODES 33010-33130, 33140, 33141, 33361-33369, 33200-37186, 37195-37785, 92950-93272,

More information

BC ADVANTAGE AUDIO SERIES:

BC ADVANTAGE AUDIO SERIES: BC ADVANTAGE AUDIO SERIES: UPDATES FOR 2015 SURGICAL CPT CODES 1 Presented by: Darlene Boschert, RHIA, CPC, CPC-H, CPC-I Providing LOW-COST educational resources for Medical office Professionals OBJECTIVES

More information

2017 ICD 10 PCS Code Updates

2017 ICD 10 PCS Code Updates 2017 ICD 10 PCS Code Updates Kimberly Cunningham CPC, CIC, CCS Copyright/Disclaimer text No part of this presentation may be reproduced or transmitted in any form or by any means (graphically, electronically,

More information

Medical Review Guidelines Magnetic Resonance Angiography

Medical Review Guidelines Magnetic Resonance Angiography Medical Review Guidelines Magnetic Resonance Angiography Medical Guideline Number: MRG2001-05 Effective Date: 2/13/01 Revised Date: 2/14/2006 OHCA Reference OAC 317:30-5-24. Radiology. (f) Magnetic Resonance

More information

Index. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.

Index. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type. Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic

More information

AMERICAN IMAGING MANAGEMENT

AMERICAN IMAGING MANAGEMENT 2012 CPT Codes Computerized Tomography (CT) CPT Description Abdomen 74150 CT abdomen; w/o 74160 CT abdomen; with 74170 CT abdomen; w/o followed by Chest 71250 CT thorax; w/o 71260 CT thorax; with 71270

More information

AMERICAN IMAGING MANAGEMENT

AMERICAN IMAGING MANAGEMENT 2010 BCBS of Georgia CPT Codes With Grouper Numbers Computerized Tomography (CT) CPT Description Abdomen 74150 CT abdomen; w/o contrast 6 74160 CT abdomen; with contrast 74170 CT abdomen; w/o contrast

More information

SUPPLEMENTAL DIGITAL CONTENT 2 : SURGERY SUBGROUPS DEFINITONS AND DISTRIBUTION

SUPPLEMENTAL DIGITAL CONTENT 2 : SURGERY SUBGROUPS DEFINITONS AND DISTRIBUTION mortality 24h in ICU mortality 24h in ICU 1 SUPPLEMETAL DIGITAL COTET 2 : SURGERY SUBGROUPS DEFIITOS AD DISTRIBUTIO =2,717,902 GHM codes* Surgery description CARDIAC SURGERY 05C021 to 05C034 Cardiac valve(s)

More information

Medical Services Protocol Updates

Medical Services Protocol Updates Protocol Medical Services Protocol Updates Distribution Date: June 1, 2018 The following medical protocol update includes information on protocols that have undergone an annual review over the last several

More information

Stroke / CVA TIA Trauma Dizziness Headaches. Acoustic Neuroma Syrinx Visual Change Vascular Lesions (AVM) Elevated Prolactin Vertigo Bell s palsy

Stroke / CVA TIA Trauma Dizziness Headaches. Acoustic Neuroma Syrinx Visual Change Vascular Lesions (AVM) Elevated Prolactin Vertigo Bell s palsy Head Brain Alzheimer s Mental Status Change Confusion Dementia Memory Loss Dizziness Headaches MRI Brain w/o 70551 Tumor / Mass / Cancer Cranial Nerve Lesions HIV Infection Suspected MS Neurofibromatosis

More information

Patient Name: Date of Birth: Preferred Pharmacy: (name/location/phone #)

Patient Name: Date of Birth: Preferred Pharmacy: (name/location/phone #) Patient Name: Date of Birth: Referring Doctor: Primary Care Dr: Preferred Pharmacy: (name/location/phone #) CURRENT MEDICATIONS: Please list all Medication Dose Frequency 1 2 3 4 5 6 7 8 9 10 11 12 13

More information

Surgical Privileges Form: "Neurosurgery" Clinical Privileges Request. Requested (To be completed by the applicant) Not Recommended (For committee use)

Surgical Privileges Form: Neurosurgery Clinical Privileges Request. Requested (To be completed by the applicant) Not Recommended (For committee use) Surgical Form: Clinical Request "Neurosurgery" Applicant s Name:. License No. (If Any):... Date:... Scope of Practice:. Facility:.. Place of Work:. the applicant) CATEGORY I: Core : 1. Interpretation of

More information

Clinical indications for positron emission tomography

Clinical indications for positron emission tomography Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will

More information

Cardiothoracic and Cardiothoracic Surgery ICD-10-CM 2014: Reference Mapping Card

Cardiothoracic and Cardiothoracic Surgery ICD-10-CM 2014: Reference Mapping Card 2014: Reference Mapping Card 162.3 Malignant neoplasm upper lobe lung 162.5 Malignant neoplasm lower lobe lung 162.9 lung/bronchus 396.2 396.3 Mitral insufficiency, aortic stenosis Mitral aortic valve

More information

2017 PHYSICIAN PROCEDURE CODE CHANGES

2017 PHYSICIAN PROCEDURE CODE CHANGES 2017 PHYSICIAN PROCEDURE CODE CHANGES Effective for dates of service on or after 1/1/2017, refer to the New Codes listed below for billing. The discontinued codes are not valid for billing dates of service

More information

Products and Services Considered Experimental and Investigational

Products and Services Considered Experimental and Investigational 0054T Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images (List separately in addition to code for primary procedure) 0055T Computer-assisted

More information

CPT Category III Codes

CPT Category III Codes CPT Category III Codes Most recent changes to the CPT Category III Codes document Addition of 35 new and/or revised Category III codes (0335T, 0509T-0542T) and guidelines accepted by the CPT Editorial

More information

clevelandclinic.org/transplant

clevelandclinic.org/transplant Hannah Hicks bone and soft tissue TRANSPL ANT RECIPIENT Dr. Joyce said I could wear high heels in the future. I m just happy about that. Hannah Hicks, 15, Solon, Ohio. Hannah was diagnosed with a solid

More information