01/01/2017 | This policy has been identified for the CPT code update.
The following CPT codes have been added to this policy, effective 01/01/2017:
0446T, 0447T, 0448T, 0449T, 0450T, 0451T, 0452T, 0453T, 0454T, 0455T, 0456T, 0457T, 0458T, 0459T, 0460T, 0461T, 0465T, 0466T, 0467T, 0468T, 22853, 22854, 22859, 22867, 22868, 22869, 22870, 27197, 27198, 28291, 28295, 31551, 31552, 31553, 31554, 31572, 31573, 31574, 31591, 31592, 33340, 33390, 33391, 36456, 36473, 36474, 36901, 36902, 36903, 36904, 36905, 36906, 36907, 36908, 36909, 37246, 37247, 37248, 37249, 43284, 43285, 58674, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62380, 93590, 93591, 93592, D6081
The following CPT codes has been deleted from this policy, effective 12/31/2016:
0019T, 0169T, 0171T, 0281T, 0282T, 0283T, 0284T, 0288T, 0336T, 0392T, 0393T, 11752, 21495, 22305, 27193, 27194, 28290, 28293, 28294, 31582, 31588, 33400, 33401, 33403, 35450, 35452, 35458, 35460, 35471, 35472, 35475, 35476, 36147, 36870, 62310, 62311, 62318, 62319, 75791, 93965
The following CPT codes have been revised in this policy, effective 01/01/2017:
FROM:
0274t percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, ct), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic
0275t percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, ct), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar
0409t insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator only
0418t interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable cardiac contractility modulation system
0419t destruction neurofibromata, extensive, (cutaneous, dermal extending into subcutaneous); face, head and neck, greater than 50 neurofibromata
0420t destruction neurofibromata, extensive, (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 neurofibromata
11603 excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm
11623 excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
19298 placement of radiotherapy afterloading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance
20240 biopsy, bone, open; superficial (eg, ilium, sternum, spinous process, ribs, trochanter of femur)
20245 biopsy, bone, open; deep (eg, humerus, ischium, femur)
28289 hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint
28292 correction, hallux valgus (bunion), with or without sesamoidectomy; keller, mcbride, or mayo type procedure
28296 correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, mitchell, chevron, or concentric type procedures)
28297 correction, hallux valgus (bunion), with or without sesamoidectomy; lapidus type procedure
28298 correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy
28299 correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy
31575 laryngoscopy, flexible fiberoptic; diagnostic
31576 laryngoscopy, flexible fiberoptic; with biopsy
31577 laryngoscopy, flexible fiberoptic; with removal of foreign body
31578 laryngoscopy, flexible fiberoptic; with removal of lesion
31579 laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
31580 laryngoplasty; for laryngeal web, two stage, with keel insertion and removal
31584 laryngoplasty; with open reduction of fracture
31587 laryngoplasty, cricoid split
33405 replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve
33406 replacement, aortic valve, with cardiopulmonary bypass; with allograft valve (freehand)
33410 replacement, aortic valve, with cardiopulmonary bypass; with stentless tissue valve
37192 repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
37650 ligation of femoral vein
37660 ligation of common iliac vein
38760 inguinofemoral lymphadenectomy, superficial, including cloquets node (separate procedure)
47538 placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; existing access
47539 placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; new access, with placement of separate biliary drainage catheter
47540 placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; new access, with placement of separate biliary drainage catheter (eg, external or internal-external)
52500 transurethral resection of bladder neck (separate procedure)
62287 decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar
66740 ciliary body destruction; cyclodialysis
67101 repair of retinal detachment, 1 or more sessions; cryotherapy or diathermy, including drainage of subretinal fluid, when performed
67105 repair of retinal detachment, 1 or more sessions; photocoagulation, including drainage of subretinal fluid, when performed
92235 fluorescein angiography (includes multiframe imaging) with interpretation and report
92240 indocyanine-green angiography (includes multiframe imaging) with interpretation and report
TO:
0274T Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), single or multiple levels, unilateral or bilateral; cervical or thoracic
0275T Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), single or multiple levels, unilateral or bilateral; lumbar
0409T Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator only
0418T Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, implantable cardiac contractility modulation system
0419T Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); face, head and neck, greater than 50 neurofibromas
0420T Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 neurofibromas
11603 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm
11623 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
19298 Placement of radiotherapy after loading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance
20240 Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx)
20245 Biopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft)
28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant
28292 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method
28296 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method
28297 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method
28298 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method
28299 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method
31575 Laryngoscopy, flexible; diagnostic
31576 Laryngoscopy, flexible; with biopsy(ies)
31577 Laryngoscopy, flexible; with removal of foreign body(s)
31578 Laryngoscopy, flexible; with removal of lesion(s), non-laser
31579 Laryngoscopy, flexible or rigid telescopic, with stroboscopy
31580 Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion
31584 Laryngoplasty; with open reduction and fixation of (eg, plating) of fracture, includes tracheostomy, if performed
31587 Laryngoplasty, cricoid split, without graft placement
33405 Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve
33406 Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand)
33410 Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve
37192 Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
37650 Ligation of femoral vein
37660 Ligation of common iliac vein
38760 Inguinofemoral lymphadenectomy, superficial, including Cloquet's node (separate procedure)
47538 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; existing access
47539 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; new access, without placement of separate biliary drainage catheter
47540 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; new access, with placement of separate biliary drainage catheter (eg, external or internal-external)
52500 Transurethral resection of bladder neck (separate procedure)
62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar
66740 Ciliary body destruction; cyclodialysis
67101 Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapy
67105 Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulation
92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral
92240 Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral |