Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA11.037d


Attachment:A

Policy #:MA11.037d

Description:

Title:Use of an Operating Microscope During a Surgical Procedure


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.


Primary Procedures Codes That Can Be Reported With Procedure Code 69990 And May Be Eligible For Separate Reimbursement


Procedure code 69990 is eligible for separate reimbursement when reported with the following procedure codes
Procedure Code
61304
61305
61312
61313
61314
61315
61316
61320
61321
61322
61323
61330
61333
61340
61343
61345
61450
61458
61460
61500
61501
61510
61512
61514
61516
61517
61518
61519
61520
61521
61522
61524
61526
61530
61531
61533
61534
61535
61536
61538
61539
61540
61541
61543
61544
61545
61546
61550
61552
61556
61557
61558
61559
61563
61564
61566
61567
61570
61571
61575
61576
61580
61581
61582
61583
61584
61585
61586
61590
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61611
61613
61615
61616
61618
61619
61623
61624
61626
61630
61635
61640
61641
61642
61680
61682
61684
61686
61690
61692
61697
61698
61700
61702
61703
61705
61708
61710
61711
62010
62100
63081
63082
63085
63086
63087
63088
63090
63091
63101
63102
63103
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
63198
63199
63200
63250
63251
63252
63265
63266
63267
63268
63270
63271
63272
63273
63275
63276
63277
63278
63280
63281
63282
63283
63285
63286
63287
63290
63295
63300
63301
63302
63303
63304
63305
63306
63307
63308
63704
63706
63707
63709
63710
64615
64831
64834
64835
64836
64840
64856
64857
64858
64861
64862
64864
64865
64866
64868
64885
64886
64890
64891
64892
64893
64895
64896
64897
64898




Version Effective Date: 01/01/2019
Version Issued Date: 01/11/2019
Version Reissued Date: N/A

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.