Clinical Policy: Occipital Nerve Stimulation for Headache Reference Number: CP.MP.432
|
|
- Moris Francis
- 1 years ago
- Views:
Transcription
1 Clinical Policy: Reference Number: CP.MP.432 Effective Date: 11/16 Last Review Date: 11/15 See Important Reminder at the end of this policy for important regulatory and legal information. Description Medical necessity criteria for the review of occipital nerve stimulation (ONS), also called peripheral nerve stimulation (PFS), a form of neuromodulation therapy aimed at treating headache and craniofacial pain. Coding Implications Revision Log Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation that ONS is medically necessary only for carefully selected individuals with intractable occipital neuralgia that is refractory to standard treatment, and is having a negative impact on quality of life. II. It is the policy of health plans affiliated with Centene Corporation that ONS is investigational for any other circumstances than those specified above. Background During ONS, a neurostimulator is implanted under the skin at the base of the head. The lead is placed into the subcutaneous tissues innervated by the greater and lesser occipital nerves, and the pulse generator is implanted into a subcutaneous pocket in the chest, abdomen, or back. 4 Indications for ONS include chronic, intractable primary or secondary headache disorders and neuropathic pain involving the occipital or suboccipital region. Occipital neuralgia is a form of headache that involves the posterior scalp, in the greater or lesser occipital nerve distribution, with pain that can be severe and debilitating. 4, 7 Neurostimulation is FDA-approved for the treatment of certain intractable pain syndromes, although it is not approved for headache and craniofacial pain and thus occipital nerve stimulation represents an off-label use. 4 National Institute for Health and Care Excellence (NICE) Evidence on occipital nerve stimulation (ONS) for intractable chronic migraine shows some efficacy in the short term but very little evidence about long-term outcomes. 6 American Association of Neurological Surgeons (AANS) & Congress of Neurological Surgeons Joint Guideline Committees Based on data derived from this systematic literature review, the following Level III recommendation can be made: The use of ONS is a treatment option for patients with medically refractory occipital neuralgia. 7 Page 1 of 6
2 European Headache Federation The purpose of this group is to give an assessment and recommendation for the use of the currently available neuromodulation devices in headache treatment. Because the available data regarding the various stimulation approaches are so scarce and variable, this recommendation is also based on the definition of a clinically significant improvement. In chronic migraines the use of ONS seems acceptable although based on limited evidence. 5 Studies in the medical literature consist of small case series, retrospective studies and randomized trials with limited patient populations and short follow up. There are no welldesigned randomized control trials that compare ONS to established treatment options and clinical trials are ongoing. Some of the studies have indicated that ONS significantly reduced the pain intensity and the number of days with headache in patients with migraine, however, the evidence of ONS efficacy established by randomized controlled trials was limited. Future peerreviewed studies should optimize and standardize the ONS intervention process. Identification of the responses to various forms of neuromodulation is necessary as well as the efficacy, longterm outcomes and complications resulting from the procedure. 8, 1 Coding Implications This clinical policy references Current Procedural Terminology (CPT ). CPT is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2015, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced in this clinical policy are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the most up-to-date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services. CPT Description Codes Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve) Incision for implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve) Revision or removal of peripheral neurostimulator electrode array Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or indirect coupling Page 2 of 6
3 CPT Description Codes Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver HCPCS Codes C1778 C1816 L8680 L8681 L8682 L8683 L8685 L8686 L8687 L8688 Description Lead, neurostimulator (implantable) Receiver and/or transmitter, neurostimulator (implantable) Implantable neurostimulator electrode, each Patient programmer (external) for use with implantable programmable implantable neurostimulator pulse generator Implantable neurostimulator radiofrequency receiver Radiofrequency transmitter (external) for use with Implantable neurostimulator radiofrequency receiver Implantable neurostimulator pulse generator, single array, rechargeable, includes extension Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension ICD-10-CM Diagnosis Codes that Support Coverage Criteria ICD-10-CM Description Code G Migraine without aura G G Migraine with aura G G Migraine unspecified, intractable G G Cluster headache unspecified G G Episodic cluster headache G G Chronic cluster headache G M54.81 Occipital neuralgia R51 Headache Page 3 of 6
4 Reviews, Revisions, and Approvals Date Approval Date Adopted from Health Net NMP#432 Occipital Nerve Stimulation for Headache 11/16 11/16 References 1. Chen YF, Bramley G, Unwin G, et al. Occipital nerve stimulation for chronic migraine-a systematic review and meta-analysis. PLoS One Mar 20;10(3):e Hayes, Inc. Health Technology Brief. Electrical Stimulation of the Occipital Nerve for the Treatment of Occipital Neuralgia. January Archived January 29, Hayes Medical Technology Directory. Occipital Nerve Stimulation for Chronic Cluster Headache and Chronic Migraine Headache. May Updated April 28, Mammis A. Occipital Nerve Stimulation. Medscape. October 14, Martilletti P, Jensen RH, Antal A, et al. Neuromodulation of chronic headaches: position statement from the European Headache Federation. The Journal of Headache and Pain. October 21, National Institute for Health and Care Excellence (NICE). Occipital nerve stimulation for intractable chronic migraine. Interventional procedures guidance [IPG452]. April Sweet JA, Mitchell LS, Narouze S, et al. Occipital Nerve Stimulation for the Treatment of Patients with Medically Refractory Occipital Neuralgia: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline. Neurosurgery Sep; 77 (3): doi: /NEU. 8. Yang Y, Song M, Fan Y, et al. Occipital Nerve Stimulation for Migraine: A Systematic Review. Pain Pract Apr;16(4): doi: /papr Epub 2015 April Important Reminder This clinical policy has been developed by appropriately experienced and licensed health care professionals based on a review and consideration of currently available generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by this clinical policy; and other available clinical information. The Health Plan makes no representations and accepts no liability with respect to the content of any external information used or relied upon in developing this clinical policy. This clinical policy is consistent with standards of medical practice current at the time that this clinical policy was approved. Health Plan means a health plan that has adopted this clinical policy and that is operated or administered, in whole or in part, by Centene Management Company, LLC, or any of such health plan s affiliates, as applicable. The purpose of this clinical policy is to provide a guide to medical necessity, which is a component of the guidelines used to assist in making coverage decisions and administering Page 4 of 6
5 benefits. It does not constitute a contract or guarantee regarding payment or results. Coverage decisions and the administration of benefits are subject to all terms, conditions, exclusions and limitations of the coverage documents (e.g., evidence of coverage, certificate of coverage, policy, contract of insurance, etc.), as well as to state and federal requirements and applicable Health Plan-level administrative policies and procedures. This clinical policy is effective as of the date determined by the Health Plan. The date of posting may not be the effective date of this clinical policy. This clinical policy may be subject to applicable legal and regulatory requirements relating to provider notification. If there is a discrepancy between the effective date of this clinical policy and any applicable legal or regulatory requirement, the requirements of law and regulation shall govern. The Health Plan retains the right to change, amend or withdraw this clinical policy, and additional clinical policies may be developed and adopted as needed, at any time. This clinical policy does not constitute medical advice, medical treatment or medical care. It is not intended to dictate to providers how to practice medicine. Providers are expected to exercise professional medical judgment in providing the most appropriate care, and are solely responsible for the medical advice and treatment of members. This clinical policy is not intended to recommend treatment for members. Members should consult with their treating physician in connection with diagnosis and treatment decisions. Providers referred to in this clinical policy are independent contractors who exercise independent judgment and over whom the Health Plan has no control or right of control. Providers are not agents or employees of the Health Plan. This clinical policy is the property of the Health Plan. Unauthorized copying, use, and distribution of this clinical policy or any information contained herein are strictly prohibited. Providers, members and their representatives are bound to the terms and conditions expressed herein through the terms of their contracts. Where no such contract exists, providers, members and their representatives agree to be bound by such terms and conditions by providing services to members and/or submitting claims for payment for such services. Note: For Medicaid members, when state Medicaid coverage provisions conflict with the coverage provisions in this clinical policy, state Medicaid coverage provisions take precedence. Please refer to the state Medicaid manual for any coverage provisions pertaining to this clinical policy. Note: For Medicare members, to ensure consistency with the Medicare National Coverage Determinations (NCD) and Local Coverage Determinations (LCD), all applicable NCDs, LCDs, and Medicare Coverage Articles should be reviewed prior to applying the criteria set forth in this clinical policy. Refer to the CMS website at for additional information. Page 5 of 6
6 2016 Centene Corporation. All rights reserved. All materials are exclusively owned by Centene Corporation and are protected by United States copyright law and international copyright law. No part of this publication may be reproduced, copied, modified, distributed, displayed, stored in a retrieval system, transmitted in any form or by any means, or otherwise published without the prior written permission of Centene Corporation. You may not alter or remove any trademark, copyright or other notice contained herein. Centene and Centene Corporation are registered trademarks exclusively owned by Centene Corporation. Page 6 of 6
Clinical Policy: Laser Therapy for Skin Conditions Reference Number: CP.MP.123
Clinical Policy: Laser Therapy for Skin Conditions Reference Number: CP.MP.123 Effective Date: 08/16 Last Review Date: 07/16 Coding Implications Revision Log See Important Reminder at the end of this policy
Clinical Policy: Hyperhydrosis Treatments Reference Number: CP.MP.62
Clinical Policy: Hyperhydrosis Treatments Reference Number: CP.MP.62 Effective Date: 05/13 Last Review Date: 04/16 Coding Implications Revision Log See Important Reminder at the end of this policy for
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: spinal_cord_stimulation 3/1980 10/2015 10/2016 10/2015 Description of Procedure or Service Spinal cord stimulation
Contractor Number 11302. Oversight Region Region IV
Local Coverage Determination (LCD): Spinal Cord Stimulators for Chronic Pain (L32549) Contractor Information Contractor Name Palmetto GBA opens in new window Contractor Number 11302 Contractor Type MAC
National Coverage Determination. Vagus Nerve Stimulation (VNS)
National Coverage Determination Vagus Nerve Stimulation (VNS) Number NEURO-004 Contractor Name Wisconsin Physicians Service Insurance Corporation AMA CPT Copyright Statement CPT codes, descriptions and
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: occipital_nerve_stimulation 8/2010 5/2016 5/2017 5/2016 Description of Procedure or Service Occipital nerve
Coverage and Authorization Services is available to respond to your coding questions toll-free at 800-292-2903.
For Urinary Control Commonly Billed Codes October 2010 Medtronic provides this information for your convenience only. It is not intended as a recommendation regarding clinical practice. It is the responsibility
BOTOX Injection (Onabotulinumtoxin A) for Migraine Headaches [Preauthorization Required]
BOTOX Injection (Onabotulinumtoxin A) for Migraine Headaches [Preauthorization Required] Medical Policy: MP-RX-01-11 Original Effective Date: March 24, 2011 Reviewed: Revised: This policy applies to products
Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705)
Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705) Contractor Information Contractor Name Novitas Solutions, Inc. LCD Information Document Information LCD
Corporate Medical Policy Automated Percutaneous and Endoscopic Discectomy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: percutaneous_discectomy 9/1991 5/2016 5/2017 5/2016 Description of Procedure or Service Traditionally, discectomy
Contractor Information. LCD Information. Local Coverage Determination (LCD): HbA1c (L32939) Contract Number 11202
Local Coverage Determination (LCD): HbA1c (L32939) Contractor Information Contractor Name Palmetto GBA opens in new window Contract Number 11202 Contract Type MAC - Part B LCD Information Document Information
Neurostimulation: Orthopaedic Institute of Ohio 801 Medical Drive Lima, Ohio 45804 419-222-6622
801 Medical Drive Lima, Ohio 45804 419-222-6622 Neurostimulation is the stimulation of the spinal cord by tiny electrical impulses. An implanted lead (a flexible insulated wire), which is powered by an
MEDICAL POLICY No R6 CONTINUOUS GLUCOSE MONITORING
CONTINUOUS GLUCOSE MONITORING Effective Date: May 3, 2013 Review Dates: 2/03, 1/04, 7/04, 7/05, 6/06, 6/07, 2/08, 8/08, 8/09, 4/10, 4/11, 4/12, 4/13, 5/14, 5/15, 5/16 Date Of Origin: February 26, 2003
EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING
Status Active Medical and Behavioral Health Policy Section: Skilled Services Policy Number: IX-01 Effective Date: 04/23/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members
Continuous Glucose Monitoring System
Continuous Glucose Monitoring System Policy Number: Original Effective Date: MM.02.003 03/13/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 10/24/2014 Section: DME Place(s)
Topical Oxygen Wound Therapy (MEDICAID)
Topical Oxygen Wound Therapy (MEDICAID) Last Review Date: September 11, 2015 Number: MG.MM.DM.15C6v2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or
Electrical Stimulation and Electromagnetic Therapy for Wound Healing
Harmony Behavioral Health, Inc. Harmony Behavioral Health of Florida, Inc. Harmony Health Plan of Illinois, Inc. HealthEase of Florida, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance
How Is OnabotulinumtoxinA Reimbursed For Chronic Migraine? Impact Of FDA Approval And The New CPT Code
How Is OnabotulinumtoxinA Reimbursed For Chronic Migraine? Impact Of FDA Approval And The New CPT Code Effective January 1, 2013, physicians will be able to report the new CPT code 64615 when performing
Spinal Cord Stimulation (SCS) Therapy: Fact Sheet
Spinal Cord Stimulation (SCS) Therapy: Fact Sheet What is SCS Therapy? Spinal cord stimulation (SCS) may be a life-changing 1 surgical option for patients to control their chronic neuropathic pain and
Migraine and the greater occipital nerve
Migraine and the greater occipital nerve What is the greater occipital nerve? The nerves that travel from your spine (in the neck) to the back of the head and scalp are known as the occipital nerves. There
Local Coverage Article: Kyprolis (Carfilzomib) Coding and Billing Guidelines and Indications (A53779)
Local Coverage Article: Kyprolis (Carfilzomib) Coding and Billing Guidelines and Indications (A53779) Contractor Information Contractor Name Palmetto GBA Article Information General Information Article
CODING SHEETS CHRONIC INTRACTABLE SPASTICITY. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE
CODING SHEETS CHRONIC INTRACTABLE SPASTICITY Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572 CODMAN
Intrathecal Baclofen for CNS Spasticity
Intrathecal Baclofen for CNS Spasticity Last Review Date: November 13, 2015 Number: MG.MM.ME.31bC5 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or
Reimbursement for Physician- Administered Drugs:
Reimbursement for Physician- Purchased and Physician- Administered Drugs: Understanding the Buy and Bill Process 60889-R5-V1 This information is provided d for your background education and is not intended
Ambulatory Surgery Center Coding and Payment Guide 2015
Targeted Drug Delivery Ambulatory Surgery Center Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party
CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT. Effective January 1, 2011 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE
CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT Effective January 1, 2011 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572
NEUROMODULATION THERAPY ACCESS COALITION POSITION STATEMENT ON SPINAL CORD NEUROSTIMULATION
NEUROMODULATION THERAPY ACCESS COALITION POSITION STATEMENT ON SPINAL CORD NEUROSTIMULATION Introduction: Spinal cord stimulation (SCS) is an established treatment for chronic neuropathic pain, which can
Intraoperative Nerve Monitoring Coding Guide. March 1, 2010
Intraoperative Nerve Monitoring Coding Guide March 1, 2010 Please direct any questions to: Kim Brew Manager Reimbursement and Therapy Access Medtronic ENT (904) 279-7569 Rev 9/10 KB TO OUR PARTNERS IN
Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee
Anesthesia Services Policy Number ANES08272009RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 08/27/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable
Physician Coding and Payment Guide 2015
Targeted Drug Delivery Physician Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party sources and is subject
Medical Policy Electrostimulation and Electromagnetic Therapy for Treating Wounds
Medical Policy Electrostimulation and Electromagnetic Therapy for Treating Wounds Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description
PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING
Status Active Medical and Behavioral Health Policy Section: Behavioral Health Policy Number: X-45 Effective Date: 01/22/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services NEW product from the Medicare Learning Network (MLN) Provider Compliance Tips for Computed Tomography (CT) Scans Podcast,
MEDICAL CONTESTED CASE HEARING NO 12090 M6-12-38043-01 DECISION AND ORDER
MEDICAL CONTESTED CASE HEARING NO 12090 M6-12-38043-01 DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers Compensation Act and Rules of the Division of Workers Compensation
Billing and Coding Guidance Co-morbidities associated with morbid obesity
Billing and Coding Guidance Co-morbidities associated with morbid obesity AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT only copyright 2002-2014 American Medical Association. All Rights Reserved.
Cigna Reimbursement Policy
Cigna Reimbursement Policy Subject Robotic Assisted Surgery Table of Contents Reimbursement Policy... 1 General Background... 1 Coding/Billing Information... 2 References... 3 Policy History/Updates...
Reporting of Devices and Leads When a Credit is Received
Reporting of Devices and Leads When a Credit is Received Cardiac Rhythm Management and Electrophysiology Updated January 2014 Medicare Reporting Requirements For Full or Partial Credits of Devices and
CLINICAL POLICY Department: Medical Management Document Name: Vivitrol Reference Number: NH.PHAR.96 Effective Date: 03/12
Page: 1 of 7 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted
Economic aspects of Spinal Cord Stimulation (SCS)
Economic aspects of Spinal Cord Stimulation (SCS) Burden of Chronic Pain Chronic pain affects one in five adults in Europe 1. Up to 10 per cent of chronic pain cases are neuropathic in origin. 2 Chronic
Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.
Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons
Coding and Payment Guide for the Physical Therapist. An essential coding, billing, and payment resource for the physical therapist
Coding and Payment Guide for the Physical Therapist An essential coding, billing, and payment resource for the physical therapist 2013 Contents Introduction...1 Coding Systems... 1 Claim Forms... 3 Contents
NOVOSTE BETA-CATH SYSTEM
HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve
MEDICAL COVERAGE POLICY SERVICE: Urinary Incontinence Treatments
Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your particular benefit plan. Each benefit
UniCare Professional Reimbursement Policy
UniCare Professional Reimbursement Policy Subject: Laboratory and Venipuncture Services Policy #: UniCare 0029 Adopted: 02/02/2010 Effective: 04/05/2016 Coverage is subject to the terms, conditions, and
Global Days Policy. Approved By 7/13/2016
Global Days Policy Policy Number 2016R0005G Annual Approval Date 7/13/2016 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission
Disclaimer CODING 101 BOOT CAMP CODING SEMINAR FOR NEW PHYSICIANS
CODING 101 BOOT CAMP CODING SEMINAR FOR NEW PHYSICIANS AND STAFF Chicago Dermatological Society January 26, 2013 Presented by Joy Newby, LPN, CPC, PCS Newby Consulting, Inc. 5725 Park Plaza Court Indianapolis,
Mississippi Medicaid. Provider Reference Guide. For Part 203. Physician Services
Mississippi Medicaid Provider Reference Guide For Part 203 Physician Services This is a companion document to the Mississippi Administrative Code Title 23 and must be utilized as a reference only. January
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: vagus_nerve_stimulation 6/1998 5/2016 5/2017 5/2016 Description of Procedure or Service Stimulation of the
MEDICAL POLICY SUBJECT: GASTRIC ELECTRICAL STIMULATION
MEDICAL POLICY SUBJECT: GASTRIC ELECTRICAL PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including an
MEDICAL POLICY No. 91104-R7 DETOXIFICATION I. POLICY/CRITERIA
DETOXIFICATION MEDICAL POLICY Effective Date: January 7, 2013 Review Dates: 1/93, 2/97, 4/99, 2/01, 12/01, 2/02, 2/03, 1/04, 1/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 11/14 Date
MEDICAL POLICY No. 91503-R4 BLOOD PRESSURE MONITORS & AMBULATORY BLOOD PRESSURE MONITORING
BLOOD PRESSURE MONITORS & Effective Date: December 21, 2015 Review Dates: 01/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 11/14, 11/15 Date Of Origin: January 19, 2005 Status: Current
Local Coverage Determination (LCD): Medicine: Autonomic Function Tests (L34500)
Local Coverage Determination (LCD): Medicine: Autonomic Function Tests (L34500) Contractor Information Contractor Name Cahaba Government Benefit Administrators, LLC LCD Information Document Information
Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015
Status Active Reimbursement Policy Section: General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Observation Care Services Description:
New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee
New Patient Visit Policy Number NPV04242013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 12/16/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to
Global Surgery Fact Sheet
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Global Surgery Fact Sheet Fact Sheet Definition of a Global Surgical Package Medicare established a national definition
Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities
Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities Question 1: When will the ICD-10 Ombudsman be in place? Answer 1: The
National Medical Policy
National Medical Policy Subject: Policy Number: Vertebral Axial Decompression (VAX-D) NMP42 Effective Date*: October 2003 Updated: November 2015 This National Medical Policy is subject to the terms in
Diagnosis Coding All claim forms must include an ICD-9-CM diagnosis code to indicate the patient s principle diagnosis.
Facility Coding Most payors use the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, established to report procedures in the hospital inpatient
Evaluation & Management Provider Compliance Summary Documentation Compliance Criteria for Evaluation & Management (E&M) Services
Evaluation & Management Provider Compliance Summary Documentation Compliance Criteria for Evaluation & Management (E&M) Services Date: April 23, 2012 Source Information: Medicare Policy Purpose The United
Clinical Policy Guideline
Policy Title: External Insulin Infusion Pump Effective Date: 11/29/2001 Clinical Policy Guideline Date Reviewed: 07/22/10, 12/13/10, 02/18/11, 09/11, 01/23/13, 06/18/14, 07/29/15 I. DEFINITION An external
Neuromuscular Electrical Stimulation (NMES) Information posted May 9, NMES for Muscle Atrophy
Neuromuscular Electrical Stimulation (NMES) Information posted May 9, 2008 NMES is a benefit of the CSHCN Services Program for the treatment of muscle atrophy or to enhance the functional activity of neurologically
Pacemaker, ICD, and ICM Evaluations
Cardiac Rhythm Management // Device Monitoring Reimbursement Pacemaker, ICD, and ICM s 2016 Reimbursement Overview Effective January 1, 2016 PACEMAKER DEVICE MONITORING Common CPT Codes and National Average
Spinal Cord Stimulation Business Case for
Spinal Cord Stimulation Business Case for Failed Back Surgery Syndrome Understanding How Various Stakeholders Gauge Success in Treating Chronic Pain FBSS is a subset of chronic low back pain, which is
Intra-operative Nerve Monitoring Coding Guide. March 1, 2011
Intra-operative Nerve Monitoring Coding Guide March 1, 2011 Please direct any questions to: Patty Telgener, RN Vice President, Reimbursement Services Emerson Consultants (303) 526-7604 (office) (303) 570-2159
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: electrodiagnostic_studies 2/2008 10/2015 10/2016 10/2015 Description of Procedure or Service Electrodiagnostic
The information contained in these notes is for educational purposes and is not intended to be and is not legal advice.
PART 3: ICD-10 Coding of Diseases and Conditions (2 Hours) With Mario Fucinari DC, MCS-P Certified Insurance Consultant Certified Medical Compliance Specialist (MCS-P) Presented by Foot Levelers The information
Mandatory Reporting of National Clinical Trial (NCT) Identifier Numbers on Medicare Claims Qs & As
Mandatory Reporting of National Clinical Trial (NCT) Identifier Numbers on Medicare Claims Qs & As Background Medicare may pay for items and services in clinical research studies under three policies:
Amniotic Membrane Transplantation for Ocular Reconstruction
Last Review Date: May 27, 2016 Number: MG.MM.SU.49CaC Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
MEASURE #1: MEDICATION PRESCRIBED FOR ACUTE MIGRAINE ATTACK Headache
MEASURE #1: MEDICATION PRESCRIBED FOR ACUTE MIGRAINE ATTACK Headache Measure Description Percentage of patients age 12 years and older with a diagnosis of migraine who were prescribed a guideline recommended
Corporate Medical Policy
Corporate Medical Policy Diagnosis and Treatment of Sacroiliac Joint Pain File Name: Origination: Last CAP Review: Next CAP Review: Last Review: diagnosis_and_treatment_of_sacroiliac_joint_pain 8/2010
UNIFORM HEALTH CARRIER EXTERNAL REVIEW MODEL ACT
Model Regulation Service April 2010 UNIFORM HEALTH CARRIER EXTERNAL REVIEW MODEL ACT Table of Contents Section 1. Title Section 2. Purpose and Intent Section 3. Definitions Section 4. Applicability and
Dynamic Stretching Devices for the Treatment of Joint Stiffness and Contracture
Harmony Behavioral Health, Inc. Harmony Behavioral Health of Florida, Inc. Harmony Health Plan of Illinois, Inc. HealthEase of Florida, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance
Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities
Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities Question 1: When will the ICD-10 Ombudsman be in place? (revised 09/22/2015)
MEDICAL COVERAGE POLICY. SERVICE: Varicose Veins of the Lower Extremities. PRIOR AUTHORIZATION: Required.
Page 1 of 5 MEDICAL COVERAGE POLICY Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your
Comments and Responses Regarding Draft Local Coverage Determination: Outpatient Physical and Occupational Therapy Services
Comments and Responses Regarding Draft Local Coverage Determination: Outpatient Physical and Occupational Therapy Services As an important part of Medicare Local Coverage Determination (LCD) development,
MEDICARE PAYMENT OF TELEMEDICINE AND TELEHEALTH SERVICES January 22, 2007
MEDICARE PAYMENT OF TELEMEDICINE AND TELEHEALTH SERVICES January 22, 2007 The Center for Medicare and Medicaid Services (CMS) administers Medicare programs in the United States. Currently, Medicare provides
INPATIENT CONSULTATIONS
INPATIENT CONSULTATIONS REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 228.7 T0 Effective Date: February, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT
Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383)
Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383) Contractor Information Contractor Name First Coast Service Options, Inc. LCD Information Document Information LCD ID
Urinary Incontinence Treatment
Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. M issouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,
Local Coverage Determination (LCD): MolDX: Breast Cancer Assay: Prosigna (L36125)
Local Coverage Determination (LCD): MolDX: Breast Cancer Assay: Prosigna (L36125) Contractor Information Contractor Name Palmetto GBA LCD Information Document Information LCD ID L36125 Original ICD-9 LCD
MODERATE SEDATION POLICY
MODERATE SEDATION POLICY REIMBURSEMENT POLICY Policy Number: ANESTHESIA 002.2 T0 Effective Date: April, 206 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT
Therefore, a physician should only bill for new patient services when the elements of the definition is met.
Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
MEDICAL COVERAGE POLICY SERVICE: Urinary Incontinence Treatments
Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your particular benefit plan. Each benefit
2. For all clinical trials, the coverage analysis will also be audited to ensure compliance with the Medicare National Coverage Determination.
COMPLIANCE PROGRAM POLICY: Clinical Research Billing Audit Policy Effective Date: August 1, 2014 Last Updated: Page 1 of 8 I. POLICY All UC Irvine Health departments engaged in clinical research may be
Radiology Multiple Imaging Reduction Policy
Policy Number 2015R0085C Radiology Multiple Imaging Reduction Policy Annual Approval Date 7/8/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission
OCCIPITAL NEURALGIA AND HEADACHE TREATMENT
CLINICAL POLICY OCCIPITAL NEURALGIA AND HEADACHE TREATMENT Policy Number: PAIN 018.14 T2 Effective Date: January 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS.. BENEFIT CONSIDERATIONS.
DERMABOND Portfolio 2012 LACERATION REPAIR REIMBURSEMENT GUIDE
2012 LACERATION REPAIR REIMBURSEMENT GUIDE ETHICON, INC. IS PLEASED TO PROVIDE THIS LACERATION REPAIR REIMBURSEMENT GUIDE AS A RESOURCE FOR HEALTHCARE PROVIDERS. This guide is intended for informational
HEALTH DEPARTMENT BILLING GUIDELINES
HEALTH DEPARTMENT BILLING GUIDELINES Acknowledgement: Current Procedural Terminology (CPT ) is copyright 2015 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative
MEDICAL POLICY Treatment of Opioid Dependence
POLICY........ PG-0313 EFFECTIVE......11/11/14 LAST REVIEW... 07/14/15 MEDICAL POLICY Treatment of Opioid Dependence GUIDELINES This policy does not certify benefits or authorization of benefits, which
Sacral Nerve Neuromodulation/Stimulation
MEDICAL POLICY POLICY RELATED POLICIES POLICY GUIDELINES DESCRIPTION SCOPE BENEFIT APPLICATION RATIONALE REFERENCES CODING APPENDIX HISTORY Sacral Nerve Neuromodulation/Stimulation Number 7.01.69 Effective
2015 Coding & Payment Policy Update
The Society for Cardiovascular Angiography and Interventions presents 2015 Coding & Payment Policy Update Faculty Peter Duffy, MD, MMM, F, Secretary, 2014 2015, Advocacy and Government Relations Committee
Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures
Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures Table 1: Surgeon Billing for Laparoscopic Adjustable Gastric Band Procedures 2012 Medicare Payment 2 43770
Behavioral Health Policy Phototherapy Light for the Treatment of Seasonal Affective (SAD) and Other Depressive Disorders
Behavioral Health Policy Phototherapy Light for the Treatment of Seasonal Affective (SAD) and Other Depressive Disorders Table of Contents Policy: Commercial Coding Information Information Pertaining to
Rotator Cuff Repair Surgical Procedures
Rotator Cuff Repair Surgical Procedures 2011 Reimbursement and Coding Reference Guide for Physicians and Hospitals This coding reference guide is intended to illustrate the common CPT * codes, ICD-9 CM
Photocure 2014 Reimbursement Guide. Billing for Blue Light Cystoscopy with Cysview (hexaminolevulinate hydrochloride) Medicare Program
Photocure 2014 Reimbursement Guide Billing for Blue Light Cystoscopy with Cysview (hexaminolevulinate hydrochloride) Medicare Program Cysview (hexaminolevulinate hydrochloride) is a photodynamic optical
Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation
Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation Clinical Policy Number: 12.03.01 Effective Date: January 1, 2015 Initial Review Date: August 20, 2014 Most Recent Review Date:
Direct Current Therapy for Treatment of Hemorrhoids
Direct Current Therapy for Treatment of Hemorrhoids [For the list of services and procedures that need preauthorization, please refer to www.mcs.com.pr Go to Comunicados a Proveedores, and click Cartas
Coding and Payment Guide for Anesthesia Services
Coding and Payment Guide for Anesthesia Services An essential coding, billing, and payment resource for anesthesiology and pain management 2006 4th edition Contents Introduction...............................
Empire BlueCross BlueShield Professional Reimbursement Policy
Subject: Evaluation and Management Services and Related Modifiers -25 & 57 NY Policy: 0026 Effective: 8/19/2013 1/31/2014 Coverage is subject to the terms, conditions, and limitations of an individual
Unlisted Procedure Codes Frequently Asked Questions
Unlisted Procedure Codes Frequently Asked Questions Use of an unlisted code is common when a physician performs a new procedure or utilizes new technology when no other CPT code adequately describes the