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National Government Services Local Coverage Determinations

Welcome to the Medical Policy Center. Below you will find the LCDs and related Billing and Coding Articles. Medical Policy Articles and other coverage articles can be found below the LCD index.

[View Draft Policies | View LCDs in Notice | View Future Billing & Coding Articles]

Local Coverage Determinations

LCD LCD # Billing and Coding # Response to Comments Related CPT/HCPCS Codes
Autonomic Function Testing
Related terms: tilt table, sudomotor
L36236 A57024 A54403 95921, 95922, 95923, 95924, 95943
Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis
Related terms: N/A
L37733
A56609
A56742 81539, 84153, 84154, 86316, 81479, 0005U
Biomarker Testing for Neuroendocrine Tumors/Neoplasms
Related terms: N/A
L037851  A57059 A56247 0007M
Botulinum Toxins
Related terms: Botox, Myobloc, Dysport,Xeomin, spasticity, chemodenervation
L33646 A52848

43201, 43236, 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 67345, J0585, J0586, J0587, J0588
Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
Related terms: ultrasound, non-palpable masses, palpable masses
L33585 A52849

19030, 76641, 76642, 77046, 77047, 77048, 77049, 77053, 77054, C8903, C8905, C8906, C8908
B-type Natriuretic Peptide (BNP) Testing
Related terms: congestive heart failure, acute dyspnea
L33573 A56826

83880
Cardiac Catheterization and Coronary Angiography
Related terms: heart, circulatory
L33557 A52850

36120, 36140, 36200, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36248, 36251, 36252, 36253, 36254, 75625, 75630, 75658, 75705, 75710, 75716, 92978, 92979, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93464, 93505, 93530, 93531, 93532, 93533, 93561, 93562, 93563, 93564, 93565, 93566, 93567, 93568, 93571, 93572, G0269, G0278
Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
Related terms: heart, calcium, congenital, bypass
L33559 A56737

75571, 75572, 75573, 75574, 0501T, 0502T, 0503T, 0504T
Cardiovascular Nuclear Medicine
Related terms: cardiac scan, stress test, heart, coronary, ejection, perfusion, blood pool
L33560 A56743

78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78496, A9500, A9501, A9502, A9505, A9512, A9520, A9538, A9560, Q9969
Cataract Extraction
Related terms: eyes, ophthalmology, complex, epinephrine
L33558 A56544 A55257 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66987, 66988
Computed Tomographic (CT) Colonography for Diagnostic Uses
Related terms: virtual colonoscopy
L33562 A57026
74261, 74262
Corneal Hysteresis
Related terms: N/A
L38014
A56528
A56529 92145
Corneal Pachymetry
Related terms: cornea, ophthalmology, eyes
L33630 A56548
76514, 92499
Debridement Services
Related terms: N/A
L33614 A56617

11000, 11001, 11042, 11043, 11044, 11045, 11046, 11047, 97597, 97598
Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
Related terms: administration, compendia, FDA
L33394 A52855

N/A
EEG – Ambulatory Monitoring
Related terms: electroencephalogram
L33399 A57030
95700, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
Related terms: Radiofrequency, Neurotomy, pain, cervical, lumbar, thoracic
L35936 A57826

64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 64625
Frequency of Hemodialysis
Related terms: dialysis, kidney disease, end stage renal disease
L37475 A585672 A56252 90999
Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases
Related terms: N/A
L37606 A56793
A55974 81450
Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms
Related terms: N/A
L37810 A56867
A56216 0048U, 81445
Heavy Metal Testing 
Related terms: metal toxicity, aluminum, arsenic, iron, lead, nickel, zinc, mercury
L35074 A56767

82108, 82175, 82300, 82495, 82525, 83015, 83018, 83655, 83785, 83825, 83885, 84255, 84285, 84630, 84999
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
Related terms: N/A
L38387 A57092
64568, 0466T, 0467T, 0468T
Implantable Miniature Telescope (IMT)
Related terms: eye, blindness
L33584 A57411
A55261 C1840, 0308T
Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures
Related terms: paronychia, skin, carbuncle, boil
L33563 A56766

10060, 10061, 10080, 10081, 10140, 10160, 10180
Lumbar Epidural Injections
Related terms: spine, pain, transforaminal, sacral, steroid, spinal
L35937  A57494
62322, 62323, 62326, 62327, 64483, 64484
Magnetic Resonance Angiography (MRA)
Related terms: gadolinium, contrast, imaging
L33633 A56747

70544, 70545, 70546, 70547, 70548, 70549, 71555, 72159, 72198, 73225, 73725, 74185, C8900, C8901, C8902, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor
Related terns: N/A
L37421 A57435
A55848 0398T
Micro-Invasive Glaucoma Surgery (MIGS)
Related terms: N/A
L37244 A56588
A56783 0191T, 0376T, 0449T, 0450T, 0474T
Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
Related terms: iFuse
L36406 A57431

27279
Molecular Pathology Procedures
Related terms: genetic testing, genetic counseling, gene, Tier 1, Tier 2
L35000 A56199 A55982 81120, 81121, 81162, 81163, 81164, 81165, 81166, 81167, 81170, 81175, 81176, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81235, 81236, 81237, 81245, 81246, 81256, 81261, 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81270, 81272, 81273, 81275, 81276, 81287, 81301, 81305, 81307, 81308, 81309, 81310, 81311, 81313, 81314, 81315, 81316, 81332, 81334, 81335, 81340, 81341, 81342, 81345, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81518, 81519, 81520, 81595, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81233, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81306, 81312, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81333, 81343, 81344, 81599, 81105‒81112, 81161, 81171, 81172, 81173, 81174, 81200, 81201, 81202, 81203, 81204, 81205, 81227, 81228, 81229, 81230, 81231, 81232, 81234, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81257, 81258, 81259, 81260, 81269, 81271, 81274, 81277, 81283, 81284, 81285, 81286, 81289, 81290, 81291, 81302, 81303, 81304, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81336, 81337, 81346, 81350, 81355, 81361‒81364, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81448, 81455, 81460, 81465, 81470, 81471, 81493, 81500, ,81503, 81504, 81507, 81521, 81522, 81525, 81535, 81536, 81538, 81540, 81541, 81542, 81545, 81551, 81552
Multimarker Serum Tests Related to Ovarian Cancer Testing
Related terms: N/A
L38371 A57020 A58112 81500, 81503, 0003U
Nerve Conduction Studies and Electromyography
Related terms: electrodiagnostic, neurologic, EMG, NCS, neuromuscular, motor, needle
L35098 A57668

51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937, 95999, G0255
Noninvasive Vascular Studies
Related terms: NonInvasive, leg, clot, plethysmography, duplex scan, Doppler, cerebrovascular, arterial, venous, hemodialysis
L33627 A56758

93880, 93882, 93886, 93888, 93890, 93892, 93893, 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93970, 93971, 93975, 93976, 93978, 93979, 93970, 93971, 93985, 93986, 93990
Nonvascular Extremity Ultrasound
Related terms: clot, plantar fasciitis
L33619 A56787

76881, 76882
Ophthalmic Biometry for Intraocular Lens Power Calculation
Related terms: cataract, biometry, eyes
L33621 A56549
76519, 92136
Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Related terms: retinal, retinopathy, chorioretinitis, vitreous
L33567 A56726
92201, 92202, 92227, 92228, 92250
Osteopathic Manipulative Treatment
Related terms: somatic, skeletal, dysfunction
L33616 A56954
A55318 98925, 98926, 98927, 98928, 98929
Outpatient Physical and Occupational Therapy Services
Related terms: maintenance, restorative, skilled, modality, therapeutic, exercise, manual, cast, splint, biofeedback
L33631 A56566
29065, 29075, 29085, 29086, 29105, 29125, 29126, 29130, 29131, 29200, 29240, 29260, 29280, 29345, 29355, 29365, 29405, 29425, 29445, 29505, 29515, 29520, 29530, 29540, 29550, 29580, 29799, 90901, 90912, 90913, 95851, 95852, 95992, 96125, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97535, 97537, 97542, 97602, 97605, 97606, 97607, 97608, 97750, 97755, 97760, 97761, 97763, 97799, G0281, G0283, G0295, G0329
Pain Management
Related terms: spine, spinal, trigger, injection, ganglion
L33622 A52863

20526, 20550, 20551, 20552, 20553, 20560, 20561, 20612, 27096, 28899, 64451, 64625, G0260
Panretinal (Scatter) Laser Photocoagulation
Related terms: N/A
L33628 A56550
67228
Percutaneous Coronary Intervention
Related terms: heart, angina, intracoronary
L33623 A56823

92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944, 92973, 92975, 92978, 92979, 93571, 93572, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608
Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
Related terms: compression, spine, fracture
L33569 A56178
A57436 22510, 22511, 22512, 22513, 22514, 22515, 76380
Peripheral Nerve Blocks
Related terms: N/A
L36850 A57452
A55421 64400, 64405, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64445, 64446, 64447, 64448, 64449, 64450, 64455, 64454, 64624, 20560, 20561
Posterior Tibial Nerve Stimulation for Voiding Dysfunction
Related terms: overactive bladder, urinary urgency, urinary frequency, urinary incontinence, percutaneous electrical stimulation
L33396 A57453

64566
Prostate Rectal Spacers
Related terms: N/A
L37485 A756539
A58100 55874
Proton Beam Therapy
Related terms: radiation, radiotherapy

L35075

A56827
A55124 77520, 77522, 77523, 77525
Psychiatric Inpatient Hospitalization
Related terms: active treatment
L33624 A56865

N/A
Psychiatric Partial Hospitalization Programs
Related terms: mental illness, family counseling, vocational training
L33626 A56850

90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90849, 90853, 90899, 96101, 96102, 96103, 96116, 96118, 96119, 96120, G0129, G0176, G0177, G0410, G0411
Psychiatry and Psychology Services
Related terms: psychiatric, mental illness, Psychotherapy, electroconvulsive therapy, ECT, psychological testing, vocational training, dementia
L33632 A56937

90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90865, 90870, 90880, 90885, 90887, 90889, 90899, 96105, 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, G0451
RAST Type Tests
Related terms: FAST, Radioallergosorbent, fluoroallergosorbent, antigen, allergen, IGE
L33591 A56844

86001, 86003, 86005, 86008
Reduction Mammaplasty
Related terms: breast reconstruction, cosmetic surgery
L35001 A56837

19316, 19318
Routine Foot Care and Debridement of Nails
Related terms: feet, toes, toenails, corns, calluses, trimming of nails, systemic disease
L33636 A57759

11055, 11056, 11057, 11719, 11720, 11721, G0127
Salvage High-intensity Focused Ultrasound (HIFU) Treatment in Prostate Cancer (PCa)
Related terms: N/A
L38262 A56702 A57835 55899, C9747
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Related terms: OCT, eyes, cornea, glaucoma
L34380 A56537
92132, 92133, 92134
Select Minimally Invasive GERD Procedures
Related terms: N/A
L35080 A56863
A57890 43210, 43257, 43284, 43499, 43999, 49999
Speech-Language Pathology
Related terms: dysphagia, swallowing, communication
L33580 A52866
31579, 92507, 92508, 92521, 92522, 92523, 92524, 92597, 92607, 92608, 92609, 92626, 92627, 96105, 96110, 96112, 96113, 97129, 97130, 97533, G0451
Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) Related terms: Related terms: ionizing, stereotactic guidance, robotic L35076 A56874

77371, 77372, 77373, 77432, 77435, G0339, G0340
Total Joint arrArthroplasty
Related terms: Knee, TKA, Hip, THA
L36039 A57428

27130, 27132, 27134, 27137, 27138, 27445, 27447, 27486, 27487
Transcranial Magnetic Stimulation
Related terms: depression, major depressive disorder, magnetic field
L33398 A57528
A58145 90867, 90868, 90869
Transesophageal Echocardiography (TEE)
Related terms: ultrasound, esophagus, doppler, color flow, contrast, heart
L33579 A52868

76376, 76377, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93320, 93321, 93325, C8925, C8926, C8927
Transrectal Ultrasound
Related terms: prostate, ultrasound, echography
L33578 A57427

76872, 76873
Transthoracic Echocardiography (TTE)
Related terms: cardiac, doppler, stress, cardovascular, myocardial, heart, contrast
L33577 A56781

76376, 76377, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350, 93351, 93352, A9700, C8921, C8922, C8923, C8924, C8928, C8929, C8930, J0153, J0280, J0461, J1245, J1250, J2785, Q9955, Q9956, Q9957
Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea
Related Terms: N/A
L37929 A57548
A56267 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, C1787, C1823
Urine Drug Testing
Related terms: UDT, substance use disorder, SUD, chronic opioid therapy, COT
L36037 A56761

80305, 80306, 80307, G0480, G0481, G0482, G0483
Urodynamics
Related terms: cystometrogram, uroflowmetry, urethral pressure profile, sphincter electromyogram, sphincter electromyogram, incontinence, voiding dysfunction
L33576 A57455

51726, 51727, 51728, 51729, 51736, 51741, 51792, 51797
Varicose Veins of the Lower Extremity, Treatment of
Related terms: telangiectasia, spider veins, cosmetic, ligation and stripping, Endovenous radiofrequency ablation, EFRA, laser ablation
L33575 A52870
A55704 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37799
 
Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency
Related terms: CCSVI, multiple sclerosis, MS
L35028 A56845

37248, 37249
Visual Electrophysiology Testing
Related terms: N/A
L36831  A57060 A55475 92273, 92274, 95930, 0509T, 0333T, 0464T
Visual Fields Testing
Related terms: eyes, ophthalmology, vision
L33574 A56551
92081, 92082, 92083
Vitamin D Assay Testing
Related terms: Bone Density, Osteopenia
L37535 A57736
A55852 82306, 82652
Water Vapor Thermal Therapy for LUTS/BPH
Related terms: N/A
L37808
A56590
A56736 53854
HHH LCD Title LCD# Billing and Coding #
Related CPT/HCPCS Codes
Hospice - Determining Terminal Status
Related terms: Decline, life expectancy
L33393 A52830
N/A

Supplemental Instructions/Medical Policy Articles

Article Title Article # Related CPT/HCPCS Codes
Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee – Medical Policy Article
Related Terms: injection
A52369 29877, 29999, G0289
Billing and Coding: Bevacizumab and biosimilars Related Terms: drug, retinal A52370 C9257, J9035, 67028
Billing and Coding: Bortezomib
Related Terms: drug
A52371 J9041, J9044
Billing and Coding: Denosumab (Prolia ™, Xgeva ™)
Related Terms: drug, bone
A52399 J0897, 96372
Billing and Coding: Eculizumab
Related Terms: drug, hemolysis
A54548 J1300
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars
Related Terms: drug, G-CSF
A52408 J1442, J1447, J2505, Q5101, Q5108, Q5110, Q5111, J3590
Billing and Coding: Hyaluronans Intra-articular Injections of
Related Terms: drug, knee, ankle
A52420
J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, 20610, 20611
Billing and Coding: Ibandronate Sodium
Related Terms: drug, bone  , osteoporosis
A52421 J1740
Billing and Coding: Infliximab and biosimilars
Related Terms: drug
A52423 J1745, Q5103, Q5104
Billing and Coding: Intravenous Immune Globulin (IVIG)
Related Terms: drug, immunodeficiency, ITP
A52446 96365, 96366, J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
Related Terms: drug, endometriosis, leuprolide, goserelin
A52453 11981, 11982, 11983, 96402, J1950, J3315, J3316, J9202, J9217, J9218, J9219, J9225
Billing and Coding: Nivolumab
Related Terms: drug
A54862 J9299
Billing and Coding: Omalizumab
Related Terms: drug
A52448 J2357
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
Related Terms: drug
A52450 J9264, J9267
Billing and Coding: Ranibizumab and Aflibercept
Related Terms: eye, ophthalmology, macular
A52451 67028, J0178, J2778, 67916, 67917, 67921, 67922, 67923, 67924, J0179
Billing and Coding: Rituximab, Rituximab-abbs and Rituximab and hyaluronidase human (Rituxan Hycela™)
Related Terms: drug
A52452
J9311, J9312, Q5115
Blepharoplasty - Medical Policy Article
Related Terms: eye, cosmetic
A52837 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924
Chiropractic Services – Medical Policy Article
Related Terms: subluxation, manipulation
A57889 98940, 98941, 98942
Clinical Trials – Medical Policy Article
Related Terms: IDE, Q0, modifier
A52840 N/A
Collagen Implantation for Urinary Incontinence - Medical Policy Article
Related Terms: N/A
A52374 51715, L8603, Q3031
Colorectal Cancer Screening – Medical Policy Article
Related Terms: colonoscopy, sigmoidoscopy, barium enema
A52378 81528, 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0328
CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique) - Medical Policy Article
Related Terms: staph, MRSA
A52379 87641
Health and Behavior Assessment/Intervention – Medical Policy Article
Related Terms: mental, psychologist
A52434 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171
Billing and Coding: Implantable Automatic Defibrillators
Related Terms: N/A
A56326 33202, 33203, 33215, 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, G0448
Investigational Device Exemption Requests - Medical Policy Article
Related Terms: IDE, clinical, Q0 modifier
A52841 N/A
Laparoscopic Sleeve Gastrectomy (LSG) – Medical Policy Article
Related Terms: morbid, obesity, weight
A52447 43775
Local Coverage Determination (LCD) Reconsideration Process - Medical Policy Article
Related Terms: N/A
A52842 N/A
New Local Coverage Determination (LCD) Request Process
Related Terms: N/A
A56198
N/A
Polysomnography and Sleep Studies – Medical Policy Article
Related Terms: N/A
A53019 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400
Process for Determining Self-Administered Drug Exclusions – Medical Policy Article
Related Terms: SAD
A53020 N/A
Psychological Services Coverage under the Incident to Provision for Physicians and Nonphysicians – Medical Policy Article
Related Terms: psychiatric, mental
A52825 90785, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90849, 90853, 90880, 90899
Billing and Coding: Removal of Benign Skin Lesions
Related Terms: cosmetic
A54602 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17000, 17003, 17004, 17106, 17107, 17108, 17110, 17111, 17340
Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction K Only)
Related Terms: SAD
A53021 C9399, J0135, J0270, J0364, J0593, J0599, J0630, J1324, J1438, J1559, J1562, J1595, J1628, J1675, J1744, J1815, J1817, J1830, J2170, J2212, J2354, J2440, J2502, J2760, J2940, J2941, J3030, J3031, J3110, J3355, J3357, J3490, J3590, J7999, J9212, J9213, J9216, J9218, Q0515
Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction 6 Only)
Related Terms: SAD
A53022 C9399, J0135, J0270, J0364, J0593, J0599, J0630, J1324, J1438, J1559, J1562, J1595, J1628, J1675, J1744, J1815, J1817, J1830, J2170, J2212, J2354, J2440, J2502, J2760, J2940, J2941, J3030, J3031, J3110, J3355, J3490, J3590, J3357, J7999, J9212, J9213, J9216, J9218, Q0515
Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
Related Terms: pacemaker
A54909 33206, 33207, 33208
Billing and Coding: Stem Cell Transplantation
Related Terms: marrow, BMT, autologous, allogeneic, bone
A52879 38240, 38241
Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based – Medical Policy Article
Related Terms: N/A
A53018 93282, 93283, 93284, 93287, 93289, 93292, 93295, 93296
HHH Article Article # Related CPT/HCPCS Codes
Home Health Skilled Nursing Care: Teaching and Training for Dementia Patients with Behavioral Disturbances - Medical Policy Article
Related Terms: N/A
A52845 G0164
Local Coverage Determination Reconsideration Process - Medical Policy Article
Related Terms: N/A
A52842 N/A

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