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95803 | PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R | HCPCS | Medications include – Stimulants (like Modafinil (Provigil) or Armodafinil (Nuvigil), Amphetamine-like stimulants, Methylphenidate (Aptensio XR, Concerta, and Ritalin), Sodium oxybate and other antidepressant drugs. Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. |
95783 | PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM | HCPCS | Medications include – Stimulants (like Modafinil (Provigil) or Armodafinil (Nuvigil), Amphetamine-like stimulants, Methylphenidate (Aptensio XR, Concerta, and Ritalin), Sodium oxybate and other antidepressant drugs. Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. |
95810 | Sleep study in sleep lab (6 years or older) | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95807 | Sleep study including heart rate and breathing attended by technician | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95811 | SLEEP STUDY W INTITIATION OF CPAP TX/VEN | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
G0400 | PR HOME SLEEP TEST/TYPE 4 PORTA | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95801 | Slp stdy unatnd w/anal | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95806 | Sleep study unatt&resp efft | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95805 | Sleep study, multiple trials | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95782 | PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
G0398 | PR HOME SLEEP TEST/TYPE 2 PORTA | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
G0399 | PR HOME SLEEP TEST/TYPE 3 PORTA | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95800 | Slp stdy unattended | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95808 | PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95803 | PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
95783 | PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM | HCPCS | Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run. Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement. ICD-10 Codes to Use for “Narcolepsy”
G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy
- G47.411 – Narcolepsy and cataplexy, with cataplexy
- G47.419 – Narcolepsy and cataplexy, without cataplexy
G47.42 – Narcolepsy in conditions classified elsewhere
- G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
- G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy
CPT Codes for Narcolepsy Diagnostic Testing
- 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
- 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
- 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
- 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
- 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
- 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
- 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
- G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
- G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels
Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. |
E0218 | Fluid circ cold pad w pump | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, HCPCS E0218 added
5/2/2002: Type of Service and Place of Service deleted
8/16/2005: Policy title "Polar Care" renamed "Cooling Devices," Description and Policy sections revised to be consistent with BCBSA policy # 1.01.26, Code Reference section updated, HCPCS E0236 added
4/25/2008: Policy reviewed, no changes
12/10/2009: Policy Exclusions revised to include FEP verbiage, HCPCS code E1399 added to Non-Covered Codes Table. 05/17/2011: Policy reviewed; no changes to policy statement. Removed outdated references from the Sources section. |
E0236 | Pump for water circulating pad | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, HCPCS E0218 added
5/2/2002: Type of Service and Place of Service deleted
8/16/2005: Policy title "Polar Care" renamed "Cooling Devices," Description and Policy sections revised to be consistent with BCBSA policy # 1.01.26, Code Reference section updated, HCPCS E0236 added
4/25/2008: Policy reviewed, no changes
12/10/2009: Policy Exclusions revised to include FEP verbiage, HCPCS code E1399 added to Non-Covered Codes Table. 05/17/2011: Policy reviewed; no changes to policy statement. Removed outdated references from the Sources section. |
E0218 | Fluid circ cold pad w pump | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, HCPCS E0218 added
5/2/2002: Type of Service and Place of Service deleted
8/16/2005: Policy title "Polar Care" renamed "Cooling Devices," Description and Policy sections revised to be consistent with BCBSA policy # 1.01.26, Code Reference section updated, HCPCS E0236 added
4/25/2008: Policy reviewed, no changes
12/10/2009: Policy Exclusions revised to include FEP verbiage, HCPCS code E1399 added to Non-Covered Codes Table. 05/17/2011: Policy reviewed; no changes to policy statement. Removed outdated references from the Sources section. 03/02/2012: Policy reviewed. |
E0236 | Pump for water circulating pad | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), Code Reference section completed, HCPCS E0218 added
5/2/2002: Type of Service and Place of Service deleted
8/16/2005: Policy title "Polar Care" renamed "Cooling Devices," Description and Policy sections revised to be consistent with BCBSA policy # 1.01.26, Code Reference section updated, HCPCS E0236 added
4/25/2008: Policy reviewed, no changes
12/10/2009: Policy Exclusions revised to include FEP verbiage, HCPCS code E1399 added to Non-Covered Codes Table. 05/17/2011: Policy reviewed; no changes to policy statement. Removed outdated references from the Sources section. 03/02/2012: Policy reviewed. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. |
86822 | Lymphocyte culture primed | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. |
86822 | Lymphocyte culture primed | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. Policy statement changed to state that autologous consolidation therapy in patients with previously untreated embryonal tumors showing complete or partial response to, or stable disease after, induction therapy is now considered medically necessary. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. Policy statement changed to state that autologous consolidation therapy in patients with previously untreated embryonal tumors showing complete or partial response to, or stable disease after, induction therapy is now considered medically necessary. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. Policy statement changed to state that autologous consolidation therapy in patients with previously untreated embryonal tumors showing complete or partial response to, or stable disease after, induction therapy is now considered medically necessary. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. Policy statement changed to state that autologous consolidation therapy in patients with previously untreated embryonal tumors showing complete or partial response to, or stable disease after, induction therapy is now considered medically necessary. |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. Policy statement changed to state that autologous consolidation therapy in patients with previously untreated embryonal tumors showing complete or partial response to, or stable disease after, induction therapy is now considered medically necessary. |
86822 | Lymphocyte culture primed | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. Policy statement changed to state that autologous consolidation therapy in patients with previously untreated embryonal tumors showing complete or partial response to, or stable disease after, induction therapy is now considered medically necessary. |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. Policy statement changed to state that autologous consolidation therapy in patients with previously untreated embryonal tumors showing complete or partial response to, or stable disease after, induction therapy is now considered medically necessary. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.28 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Review by MPAC, no changes
10/26/2005: Code Reference section updated, CPT codes 38230, G0355 - G0364 added to the covered table, 38204, 86812 - 86822 added to the non-covered table, J9000 - J9999 deleted, ICD9 procedure codes 41.01, 41.09 added to the covered table, 41.02, 41.03 added to the non-covered table
3/21/2006: Coding updated. CPT4/HCPCS revisions added to policy
5/21/2007: Policy reviewed, description of syngeneic and allogeneic donor types added. No change to policy statements
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
5/21/2008: Policy reviewed, no changes
04/26/2010: Title changed from “High-Dose Chemotherapy with Autologous Stem-Cell Support for Primitive Neuroectodermal Tumors (PNET) of the CNS and Ependymoma” to “Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma.” The term “PNET” was changed to “embryonal tumors” throughout the policy. Policy description updated. Policy statement changed to state that autologous consolidation therapy in patients with previously untreated embryonal tumors showing complete or partial response to, or stable disease after, induction therapy is now considered medically necessary. |
86816 | HC HLA TYPING DR/DQ SINGLE AG | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
86826 | Hla x-match noncytotoxc addl | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
S2140 | Cord blood harvesting for transplantation, allogeneic | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
86821 | Lymphocyte culture mixed | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
86813 | HC HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
86822 | Lymphocyte culture primed | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
86825 | X-MATCHAHG | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
86817 | HC HLA TYPING; DR/DQ, MULTIPLE ANTIGENS | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
S2142 | Cord blood-derived stem-cell transplantation, allogeneic | HCPCS | Policy statement reworded and ependymoma and embryonal CNS tumors are addressed separately. FEP and State and School Employee verbiage added to the Policy Exceptions section. Added new CPT codes 86825 and 86826. Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. |
86816 | HC HLA TYPING DR/DQ SINGLE AG | HCPCS | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
G0267 | Bone marrow or psc harvest | CPT | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
S2140 | Cord blood harvesting for transplantation, allogeneic | HCPCS | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
G0265 | Cryopresevation Freeze+stora | CPT | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
86813 | HC HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS | HCPCS | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
86822 | Lymphocyte culture primed | HCPCS | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
G0266 | Thawing + expansion froz cel | CPT | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
86821 | Lymphocyte culture mixed | HCPCS | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
86817 | HC HLA TYPING; DR/DQ, MULTIPLE ANTIGENS | HCPCS | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
S2142 | Cord blood-derived stem-cell transplantation, allogeneic | HCPCS | Removed CPT codes 86812, 86813, 86816, 86817, 86821, and 86822 from the non-covered table. Added HCPCS S2140 and S2142 to the non-covered table. Deleted HCPCS G0265, G0266, and G0267 from the code section as these codes were deleted on 12/31/2007. 12/28/2010: Policy reviewed; no changes. 01/17/2012: Policy reviewed; no changes. |
0240 | HC BH RESIDENTIAL FULL MONTH STAY | RC | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
30240G2 | TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, OPEN APPROACH Reduced Intensity Medsurg | ICD | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
30240G3 | TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, OPEN APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
30243Y2 | TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg | ICD | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
30243G2 | TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg | ICD | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
0243 | All Inclusive Ancillary - Specialty | RC | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
30240Y2 | TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, OPEN APPROACH Reduced Intensity Medsurg | ICD | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
30240Y3 | TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, OPEN APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
30243Y3 | TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
30243G3 | TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | 03/21/2016: Policy description updated regarding FDA regulations. Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. |
0240 | HC BH RESIDENTIAL FULL MONTH STAY | RC | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30240G2 | TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, OPEN APPROACH Reduced Intensity Medsurg | ICD | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30240G3 | TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, OPEN APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30243Y2 | TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg | ICD | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30243G2 | TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg | ICD | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
0243 | All Inclusive Ancillary - Specialty | RC | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30240Y2 | TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, OPEN APPROACH Reduced Intensity Medsurg | ICD | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30240Y3 | TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, OPEN APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30243Y3 | TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30243G3 | TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | Policy statements unchanged. 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
0240 | HC BH RESIDENTIAL FULL MONTH STAY | RC | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30240G2 | TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, OPEN APPROACH Reduced Intensity Medsurg | ICD | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30240G3 | TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, OPEN APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30243Y2 | TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg | ICD | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30243G2 | TRANSFUSION OF ALLOGENEIC RELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Reduced Intensity Medsurg | ICD | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
0243 | All Inclusive Ancillary - Specialty | RC | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30240Y2 | TRANSFUSION OF ALLOGENEIC RELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, OPEN APPROACH Reduced Intensity Medsurg | ICD | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30240Y3 | TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, OPEN APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30243Y3 | TRANSFUSION OF ALLOGENEIC UNRELATED HEMATOPOIETIC STEM CELLS INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
30243G3 | TRANSFUSION OF ALLOGENEIC UNRELATED BONE MARROW INTO CENTRAL VEIN, PERCUTANEOUS APPROACH Tandem Autologous Allogeneic Unrelated Non ICU | ICD | 05/25/2016: Policy number added. 09/30/2016: Code Reference section updated to add the following new ICD-10 procedure codes: 30240G2, 30243G2, 30240G3, 30243G3, 30240G4, 30243G4, 30240Y2, 30243Y2, 30240Y3, 30243Y3, 30240Y4, and 30243Y4. SOURCE(S)Blue Cross Blue Shield Association Policy # 8.01.28
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy. The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. |
76536 | US THYROID | HCPCS | It signifies the professional component and can be billed only by a physician, a nurse practitioner or physician assistant. Face-to-face visits with the patient can be reported using the appropriate evaluation and management code. The device component for CGM is reported using HCPCS codes. Specifically assigned HCPCS codes help to establish credibility for the medical technology used and thereby reduce claim denials. Coding for Ultrasound Evaluation
Diagnostic ultrasound and associated ultrasound guided procedures performed by endocrinologists are coded in the following manner:
- CPT 76536 – ultrasound, soft tissues of head and neck (e.g. |
76942 | US GUID NEEDLE PLCMNTPORTABLE | HCPCS | Face-to-face visits with the patient can be reported using the appropriate evaluation and management code. The device component for CGM is reported using HCPCS codes. Specifically assigned HCPCS codes help to establish credibility for the medical technology used and thereby reduce claim denials. Coding for Ultrasound Evaluation
Diagnostic ultrasound and associated ultrasound guided procedures performed by endocrinologists are coded in the following manner:
- CPT 76536 – ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, parotid), real time with image documentation
- CPT 76942 – ultrasonic guidance for needle placement (e.g. |
76536 | US THYROID | HCPCS | Face-to-face visits with the patient can be reported using the appropriate evaluation and management code. The device component for CGM is reported using HCPCS codes. Specifically assigned HCPCS codes help to establish credibility for the medical technology used and thereby reduce claim denials. Coding for Ultrasound Evaluation
Diagnostic ultrasound and associated ultrasound guided procedures performed by endocrinologists are coded in the following manner:
- CPT 76536 – ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, parotid), real time with image documentation
- CPT 76942 – ultrasonic guidance for needle placement (e.g. |
60100 | PR BIOPSY THYROID PERCUTANEOUS CORE NEEDLE | HCPCS | The device component for CGM is reported using HCPCS codes. Specifically assigned HCPCS codes help to establish credibility for the medical technology used and thereby reduce claim denials. Coding for Ultrasound Evaluation
Diagnostic ultrasound and associated ultrasound guided procedures performed by endocrinologists are coded in the following manner:
- CPT 76536 – ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, parotid), real time with image documentation
- CPT 76942 – ultrasonic guidance for needle placement (e.g. biopsy, aspiration, localization device, injection), imaging supervision and interpretation
- CPT 10022 – fine needle aspiration; with image guidance
- CPT 60100 – biopsy thyroid, percutaneous core needle
Other Services Covered
- Bone density studies – usually coverage for this service depends on the insurance carrier, and is dependent on the diagnosis codes and frequency of service. |
76942 | US GUID NEEDLE PLCMNTPORTABLE | HCPCS | The device component for CGM is reported using HCPCS codes. Specifically assigned HCPCS codes help to establish credibility for the medical technology used and thereby reduce claim denials. Coding for Ultrasound Evaluation
Diagnostic ultrasound and associated ultrasound guided procedures performed by endocrinologists are coded in the following manner:
- CPT 76536 – ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, parotid), real time with image documentation
- CPT 76942 – ultrasonic guidance for needle placement (e.g. biopsy, aspiration, localization device, injection), imaging supervision and interpretation
- CPT 10022 – fine needle aspiration; with image guidance
- CPT 60100 – biopsy thyroid, percutaneous core needle
Other Services Covered
- Bone density studies – usually coverage for this service depends on the insurance carrier, and is dependent on the diagnosis codes and frequency of service. |
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