UHC coding guidelines for colonoscopy screening
Colonoscopy Screenings and Related Subsequent Diagnostic ProceduresIn all UnitedHealthcare Medicare Advantage plans, a colonoscopy that begins as an in-network screening service is subject to the $0...
View ArticleColonoscopy Medical necessity guidelines - Part 1
Current Policy StatementHealth Net, Inc. considers colonoscopy medically necessary according to the guidelines set forth by the American Gastroenterological Association, the American Society of Colon...
View ArticleColonsocopy Not Medically Necessary: condition
Health Net, Inc. considers colonoscopy not medically necessary for any of the following circumstances:1. Chronic, stable, irritable bowel syndrome or chronic abdominal pain; there are unusual...
View ArticleEsophageal or Gastric Motility Studies—CPT and ICD-9/ICD-10 Covered...
CPT Description91010 Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report91020 Gastric motility (manometric) studiesICD 10...
View ArticleColonsocopy CPT code / HCPCS code full list - Healthnet
CPT Codes44388 Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed44389 Colonoscopy through stoma; with biopsy, single or multiple44390...
View ArticleCPT CODE 78264, 78265, A9541 and covered ICD 10 code
Gastric Emptying Scintigraphy—CPT and ICD-9/ICD-10 Covered IndicationsClaims submitted with non-covered indication will be denied as provider liable.CPT Description78264 Gastric emptying study (gastric...
View ArticleCovered ICD codes for colonsocopy services
ICD -10 CodesAØ9 Infectious gastroenteritis and colitis, unspecifiedC17-C21.8 Malignant neoplasm of small intestine, colon, rectosigmoid junction, rectum, anus and anal canalC76.3 Malignant neoplasm of...
View ArticleCPT CODE 78267, 78268, 8313, 87338 and covered ICD 10 codes
Helicobacter Pylori Testing—CPT and ICD-9/ICD-10 Covered IndicationsClaims submitted with non-covered indication will be denied as provider liable.CPT Description78267 Urea breath test, C-14...
View ArticleCoverage frequency of CPT 82270, 82274
Tufts Health Plan sets frequency limits on certain procedures based on medical necessity. The following are policies that fall within frequency limitations.Colorectal ScreeningIn accordance with CMS4,...
View ArticleBilling for Screening Colonoscopy or Sigmoidoscopy
The AMA created modifier 33 to allow providers to identify a preventive service for which, under the PPACA, there is no patient cost sharing. Use modifier 33 with a CPT code for a diagnostic/treatment...
View ArticleCPT CODE 43647, 43881, 95980 AND ITS COVERED ICD 10 K31.84
Code Description Comments43647–43648 Laparoscopy, surgical: gastric neurostimulator procedures43881-43882 Gastric neurostimulator, procedures open95980–95982 Electronic analysis of implanted...
View ArticleNo need to use multiple procedure modifiers
Important Changes for Submitting Routine/Screening Colonoscopy ClaimsWe want to make you aware of recent changes that impact submitting claims for routine/screening colonoscopy services performed at an...
View ArticleHelicobacter Pylori Testing—CPT and ICD-9/ICD-10 Covered Indications
CPT Description78267 Urea breath test, C-14 (isotopic); acquisition for analysis78268 Urea breath test, C-14 (isotopic); analysis83009 Helicobacter pylori, blood test analysis for urease activity,...
View ArticleGastroenterology CPT code list
Code Description Comments31525, 31575 Diagnostic laryngoscopy43215 Esophagoscopy for removal of foreign body43220 Esophageal endoscopy dilation43257 (Stretta procedure) Upper gastrointestinal endoscopy...
View ArticleEGD CPT CODE LIST - 43233, 43251 AND 43270 - Coverage limitation
Diagnostic and Therapeutic EsophagogastroduodenoscopyCPT/HCPCS Codes43233Egd balloon dil esoph30 mm/>43235Egd diagnostic brush wash43236Uppr gi scope w/submuc inj43237Endoscopic us exam...
View ArticleEGD covered ICD 10 codes
ICD-10 Codes that Support Medical NecessityB25.2Cytomegaloviral pancreatitisB37.81Candidal esophagitisC15.3Malignant neoplasm of upper third of esophagusC15.4Malignant neoplasm of middle third of...
View ArticlePayment policy for Modifer 59 with colonoscopy procedure 45380 , 45382 and 45386
Policy:Horizon BCBSNJ will not recognize the application of Modifier 59 when applied to colonoscopy services 45380, 45382, or 45386 when performed with another colonoscopyservice (CPT® code 45380,...
View ArticleScreening and Diagnostic Mammography CPT CODE 77051, 77063, G0202, G0279
CPT/HCPCS Codes77051Computer dx mammogram add-on77052Comp screen mammogram add-on77055Mammogram one breast77056Mammogram both breasts77057Mammogram screening77063Breast tomosynthesis...
View ArticleScreening Mammogram revenue code 0400, 0521 - covered ICD CODE - Modifier GG
Revenue CodesCodeDescription0400Other Imaging Services - General Classification0401Other Imaging Services - Diagnostic Mammography0403Other Imaging Services - Screening Mammography0521Freestanding...
View ArticleColonscopy covereage guidelines
CoverageCoverage guidelines for colonoscopies are dependent upon the type of service being rendered.Diagnostic and Surgical EndoscopyA diagnostic endoscopy is a covered service if it is proven to be...
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