Connection supplemental articles and policies - March 2007

15830

Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy

15847

Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (e.g., abdominoplasty) (includes umbilical transposition and fascial plication) (list separately in addition to code for primary procedure)

19105

Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma

19300

Mastectomy for gynecomastia

19301

Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy);

19302

Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy

19303

Mastectomy, simple, complete

19304

Mastectomy, subcutaneous

19305

Mastectomy, radical, including pectoral muscles, axillary lymph nodes

19306

Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation)

19307

Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle

22526

Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level

22527

Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; one or more additional levels (list separately in addition to code for primary procedure)

22857

Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, single interspace

22862

Revision including replacement of total disc arthroplasty (artificial disc) anterior approach, lumbar, single interspace

22865

Removal of total disc arthroplasty (artificial disc), anterior approach, lumbar, single interspace

32998

Ablation therapy for reduction or eradication of one or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral

43647

Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum

43648

Laparoscopy, surgical; revision or removal of gastric neurostimulator electrodes, antrum

43881

Implantation or replacement of gastric neurostimulator electrodes, antrum, open

43882

Revision or removal of gastric neurostimulator electrodes, antrum, open

55875

Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy

55876

Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

83698

Lipoprotein-associated phospholipase A2, (LP-PLA2)

83913

Molecular diagnostics; RNA stabilization

91111

Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus with physician interpretation and report

92025

Computerized corneal topography, unilateral or bilateral, with interpretation and report

92640

Diagnostic analysis with programming of auditory brainstem implant, per hour

94774

Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, physician review, interpretation, and preparation of a report

94775

Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitor attachment only (includes hook-up, initiation of recording and disconnection)

94776

Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitoring, download of information, receipt of transmission(s) and analyses by computer only

94777

Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; physician review, interpretation and preparation of report only

96020

Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or psychologist, with review of test results and report

A4600

Sleeve for intermittent limb compression device, replacement only, each

A4601

Lithium ion battery for non-prosthetic use, replacement

A8000

Helmet, protective, soft, prefabricated, includes all components and accessories

A8001

Helmet, protective, hard, prefabricated, includes all components and accessories

A8002

Helmet, protective, soft, custom fabricated, includes all components and accessories

A8003

Helmet, protective, hard, custom fabricated, includes all components and accessories

A8004

Soft interface for helmet, replacement only

A9279

Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified

C1821

Interspinous process distraction device (implantable)

C9232

Injection, idursulfase, 1 mg

C9233

Injection, ranibizumab, 0.5 mg

C9234

Injection, alglucosidase alfa, 10 mg

C9235

Injection, panitumumab, 10 mg

C9350

Microporous collagen tube of non-human origin, per centimeter length

C9351

Acellular dermal tissue matrix of non-humn origin, per square centimeter (do not report C9351 in conjunction with J7345)

D0145

Oral evaluation for a patient under three years of age and counseling with primary caregiver

D0273

Bitewings - three films

D0360

Cone beam ct - craniofacial data capture

D0362

Cone beam - two-dimensional image reconstruction using existing data, includes multiple images

D0363

Cone beam - three-dimensional image reconstruction using existing data, includes multiple images

D0486

Accession of brush biopsy sample, microscopic examination, preparation and transmission of written report

D1206

Topical fluoride varnish; therapeutic application for moderate to high caries risk patients

D1555

Removal of fixed space maintainer

D4230

Anatomical crown exposure - four or more contiguous teeth per quadrant

D4231

Anatomical crown exposure - one to three teeth per quadrant

D6012

Surgical placement of interim implant body for transitional prosthesis: endosteal implant

D6091

Replacement of semi-precision or precision attachment (male or female component) of implant/abutment supported prosthesis, per attachment

D6092

Recement implant/abutment supported crown

D6093

Recement implant/abutment supported fixed partial denture

D7292

Surgical placement: temporary anchorage device [screw retained plate] requiring surgical flap

D7293

Surgical placement: temporary anchorage device requiring surgical flap

D7294

Surgical placement: temporary anchorage device without surgical flap

D7951

Sinus augmentation with bone or bone substitutes

D7998

Intraoral placement of a fixation device not in conjunction with a fracture

D8693

Rebonding or recementing; and/or repair, as required, of fixed retainers

D9120

Fixed partial denture sectioning

D9612

Therapeutic parenteral drugs, two or more administrations, different medications

E0676

Intermittent limb compression device (includes all accessories), not otherwise specified

E0936

Continuous passive motion exercise device for use other than knee

J0129

Injection, abatacept, 10 mg

J0348

Injection, anadulafungin, 1 mg

J0364

Injection, apomorphine hydrochloride, 1 mg

J0894

Injection, decitabine, 1 mg

J1458

Injection, galsulfase, 1 mg

J1562

Injection, immune globulin, subcutaneous, 100 mg

J1740

Injection, ibandronate sodium, 1 mg

J2170

Injection, mecasermin, 1 mg

J2248

Injection, micafungin sodium, 1 mg

J2315

Injection, naltrexone, depot form, 1 mg

J3243

Injection, tigecycline, 1 mg

J3473

Injection, hyaluronidase, recombinant, 1 USP unit

J7187

Injection, von Willebrand factor complex, human, ristocetin cofactor, per IU VWF:RCO

J7319

Hyaluronan (sodium hyaluronate) or derivative, intra-articular injection, per injection

J7345

Dermal (substitute) tissue of non-human origin, with or without other bioengineered or processed elements, without metabolically active elements, per square centimeter

J7346

Dermal (substitute) tissue of human origin, injectable, with or without other bioengineered or processed elements, but without metabolically active elements, 1 cc

J8650

Nabilone, oral, 1 mg

J9261

Injection, nelarabine, 50 mg

L1001

Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment

L3806

Wrist hand finger orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface material, straps, custom fabricated, includes fitting and adjustment

L3808

Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment

L3915

Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, includes fitting and adjustment

L5993

Addition to lower extremity prosthesis, heavy duty feature, foot only, (for patient weight greater than 300 lbs)

L5994

Addition to lower extremity prosthesis, heavy duty feature, knee only, (for patient weight greater than 300 lbs)

L6611

Addition to upper extremity prosthesis, external powered, additional switch, any type

L6624

Upper extremity addition, flexion/extension and rotation wrist unit

L6639

Upper extremity addition, heavy duty feature, any elbow

L6703

Terminal device, passive hand/mitt, any material, any size

L6704

Terminal device, sport/recreational/work attachment, any material, any size

L6706

Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined

L6707

Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined

L6708

Terminal device, hand, mechanical, voluntary opening, any material, any size

L6709

Terminal device, hand, mechanical, voluntary closing, any material, any size

L7007

Electric hand, switch or myoelectric controlled, adult

L7008

Electric hand, switch or myoelectric, controlled, pediatric

L7009

Electric hook, switch or myoelectric controlled, adult

L8690

Auditory osseointegrated device, includes all internal and external components

L8691

Auditory osseointegrated device, external sound processor, replacement

Q4081

Injection, epoetin alfa, 100 units (for ESRD on dialysis)

Q4082

Drug or biological, not otherwise classified, part b drug competitive acquisition program (CAP)

S0180

Etonogestrel (contraceptive) implant system, including implants and supplies

S3855

Genetic testing for detection of mutations in the presenilin - 1 gene