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Reason for Update |
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Bioengineered Skin
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Added the following new 2007 HCPCS codes, J7345 and J7346 to "Billing/Coding" section. Deleted HCPCS code, J7350.
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Bone Mineral Density Studies
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CPT codes 77078, 77079, 77080, 77081 and 77083 effective January 1, 2007 added to Billing/Coding section. Removed deleted CPT codes 76070, 76071, 76075, 76076 and 76078.
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Cervicography
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Specialty Matched Consultant Advisory Panel review 12/13/2006. No changes to criteria. CPT Code 0003T removed from Billing/Coding section. Code has been deleted from CPT Codebook. Reference source added.
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Chiropractic Services
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Clarified under "When Not Covered' "4.G. low level laser therapy (cold laser therapy) is considered investigational for all indications".
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Electrical Stimulators, Neuromuscular
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Added HCPCS codes L8680, L8681, L8682, L8683, L8685, L8686, L8687, L8688, and L8689 to the "Billing/Coding" section.
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Hormone Pellet Implantation for Hormone Replacement Therapy in Women
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Specialty Matched Consultant Advisory Panel review 12/13/2006. No changes to criteria. Reference source added.
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Mohs' Micrographic Surgery
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CPT codes 17311, 17312, 17313, 17314 and 17315 effective January 1, 2007 added to Billing/Coding section. Removed deleted CPT codes 17304, 17305, 17306, 17307 and 17310.
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Myolysis of Uterine Fibroids
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Specialty Matched Consultant Advisory Panel 12/2006. No changes. Reference Sources added.
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Ovarian and Internal Iliac Vein Embolization
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Specialty Matched Consultant Advisory Panel review 12/13/2006. No changes to criteria. Reference sources added.
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Preventing Premature Labor and Delivery
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Specialty Matched Consultant Advisory Panel review - 12/13/06. Under Section II - Progesterone Therapy in High Risk Pregnancies, second paragraph, added "by a health care professional" to the following sentence: "Administration of 17 alpha-hydroxyprogesterone caproate or vaginal suppositories in the home setting by a health professional is considered not medically necessary." Reference sources added. No other changes.
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Prostate Cancer Treatment with Brachytherapy
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CPT code 55875 effective January 1, 2007 added to Billing/Coding section. Removed deleted CPT code 55859.
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Salivary Hormone Tests for Menopause
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Specialty Matched Consultant Advisory Panel review - 12/13/2006. No changes to criteria. Reference source added.
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Spinal Cord Stimulation
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Stimulation Added HCPCS codes L8680, L8681, L8682, L8683, L8685, L8686, L8687, L8688 and L8689 to "Billing/Coding" section.
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Spinal Surgery Using Interspinous Distraction Technology
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Added new 2007 CPT codes 0171T and 0172T to "Billing/Coding" section.
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Surgery for Morbid Obesity
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Description section revised to include detailed description of surgical procedures for morbid obesity. When covered section revisions: Removed B.3. Vertical-banded gastric partition (also called vertical banded gastroplasty); Added C. Reoperation and Surgical Revision which includes the most common complications/conditions/diagnoses for which reoperation or surgical revisions are performed. When not covered section revisions: Added 2.f. Sleeve gastrectomy, either as the sole procedure or as one step in a staged procedure; 2.g. Gastric bypass using a Billroth II type of anastomosis, popularized as the mini-gastric bypass (this replaced the previous wording re: mini-gastric bypass which was removed); 2.h. Gastric electrical stimulation; 2.i. Garren-Edwards Gastric Bubble (aka, intra-gastric balloon); 2.j. Roux-en-Y is not indicated for a failed Nissen Fundoplasty unless the patient meets the other criteria for surgery for morbid obesity; 3. Vertical-banded gastroplasty was once the most common type of gastric restrictive procedure performed in the U.S., but has fallen out of favor due to a high reoperation rate. Therefore, vertical-banded gastroplasty is no longer a standard of care and is therefore considered not medically necessary. Reference sources and medical terms added. Notification given 11/13/06. Effective date 1/17/07.
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Surgical Interruption of Pelvic NervePathways for Dysmenorrhea
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Specialty Matched Consultant Advisory Panel review - 12/13/2006. No changes to criteria. Reference sources added.
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Vagus Nerve Stimulation
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Added HCPCS codes L8680, L8681, L8682, L8683, L8685, L8686, L8687, L8688, and L8689 to "Billing/Coding" section.
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Whole Body Integumentary Photography, Dermatoscopy (MED1482)
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Integumentary Photography, Dermatoscopy (MED1482) CPT code 96904 effective January 1, 2007 added to Billing/Coding section. Removed deleted CPT codes 0044T and 0045T. No changes in policy critera.
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Evidence Based Guidelines
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Reason for Update
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Hospice Care
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Added the following new 2007 HCPCS codes to the "Billing/Coding" section: Q5001, Q5002, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, and Q5009.
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Intrauterine Ablation or Resection of the Endometrium
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Specialty Matched Consultant Advisory Panel - 12/12/2006. No changes to criteria. Billing/Coding section revised. Reference sources added.
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Uterine Artery Occlusion in the Treatment of Uterine Fibroids
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CPT code 37210 effective January 1, 2007 added to Billing/Coding section. Removed deleted CPT code S2250.
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