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45385 | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
45332 | Sigmoidoscopy w/fb removal | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
45307 | PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
44390 | PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
45384 | Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
44393 | Colonoscopy lesion removal | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
G0107 | COLOREC CANCR SCR; FECAL-OCCULT BLD TST 1-3 | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
45339 | Sigmoidoscopy w/ablate tumr | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
45345 | Sigmoidoscopy w/stent | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
44392 | PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
0066T | Ct Colonography;Screen | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
45382 | PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
G0328 | PR FECAL BLOOD SCRN IMMUNOASSAY | HCPCS | 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. |
44397 | Colonoscopy w/stent | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
0067T | Ct Colonography;Dx | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45338 | SIG.SCOPE W SNARE REMOVAL | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45387 | Colonoscopy w/stent | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
G0102 | PR PROSTATE CA SCREENING; DRE | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45333 | SIG.SCOPE W HOT BX RMV | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45383 | Lesion removal colonoscopy | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
44394 | PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45385 | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45332 | Sigmoidoscopy w/fb removal | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45307 | PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
44390 | PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45384 | Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
44393 | Colonoscopy lesion removal | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
G0107 | COLOREC CANCR SCR; FECAL-OCCULT BLD TST 1-3 | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45339 | Sigmoidoscopy w/ablate tumr | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45345 | Sigmoidoscopy w/stent | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
44392 | PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
0066T | Ct Colonography;Screen | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
45382 | PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
G0328 | PR FECAL BLOOD SCRN IMMUNOASSAY | HCPCS | 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. |
G0107 | COLOREC CANCR SCR; FECAL-OCCULT BLD TST 1-3 | HCPCS | CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. |
0067T | Ct Colonography;Dx | HCPCS | CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. |
0066T | Ct Colonography;Screen | HCPCS | CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. |
0066T | Ct Colonography;Screen | HCPCS | ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. |
G0107 | COLOREC CANCR SCR; FECAL-OCCULT BLD TST 1-3 | HCPCS | ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. |
0067T | Ct Colonography;Dx | HCPCS | ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. |
74263 | HC CT COLONOGRAPHY, SCREEN | HCPCS | ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. |
74262 | HC CT VIRTUAL COLONOSCOPY DIAGNOSTIC W CONTRAST | HCPCS | ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. |
74261 | HC CT VIRTUAL COLONOSCOPY WO | HCPCS | ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. |
0066T | Ct Colonography;Screen | HCPCS | CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. 07/12/2012: Policy reviewed; no changes to policy statement. |
G0107 | COLOREC CANCR SCR; FECAL-OCCULT BLD TST 1-3 | HCPCS | CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. 07/12/2012: Policy reviewed; no changes to policy statement. |
0067T | Ct Colonography;Dx | HCPCS | CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. 07/12/2012: Policy reviewed; no changes to policy statement. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. 07/12/2012: Policy reviewed; no changes to policy statement. |
74263 | HC CT COLONOGRAPHY, SCREEN | HCPCS | CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. 07/12/2012: Policy reviewed; no changes to policy statement. |
74262 | HC CT VIRTUAL COLONOSCOPY DIAGNOSTIC W CONTRAST | HCPCS | CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. 07/12/2012: Policy reviewed; no changes to policy statement. |
74261 | HC CT VIRTUAL COLONOSCOPY WO | HCPCS | CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. HCPC code G0107 deleted from covered table due to code was deleted as of 12-31-06. 04/12/2010: Policy Statement revised to include CT Colonography may be considered medically necessary in patients with medical reasons. Code Reference Section updated revised to identify deleted codes S0605, 0066T and 0067T. Added new CPT Code 74261 and 74262 to the Covered Codes Table and CPT Code 74263 to Non-Covered Codes Table. 07/12/2012: Policy reviewed; no changes to policy statement. |
45379 | Removal of foreign bodies in large bowel using a flexible endoscope | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
0067T | Ct Colonography;Dx | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45333 | SIG.SCOPE W HOT BX RMV | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45388 | PR COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45389 | PR COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45385 | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45393 | PR COLONOSCOPY FLEXIBLE WITH DECOMPRESSION | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45332 | Sigmoidoscopy w/fb removal | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45349 | Sigmoidoscopy w/resection | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
G6024 | Lesion removal colonoscopy | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44390 | PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45384 | Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
G6022 | Sigmoidoscopy w/ablate tumr | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44405 | PR COLONOSCOPY STOMA W/BALLOON DILATION | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45390 | PR COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45346 | Sigmoidoscopy w/ablation | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45398 | PR COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S) | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44403 | PR COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45350 | SIGMOIDOSCOPY FLEX W/BND LGT | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45347 | Sigmoidoscopy w/plcmt stent | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44388 | PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44408 | PR COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
G6025 | Colonoscopy w/stent | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44406 | PR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45399 | HC UNLISTED PROCEDURE COLON | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44392 | PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
G6023 | Sigmoidoscopy w/stent | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44402 | PR COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
0066T | Ct Colonography;Screen | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45330 | SIG.SCOPE FLEXIBLE DIAGNOST | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
G6020 | Colonoscopy w/stent | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45378 | PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44401 | PR COLONOSCOPY STOMA ABLATION LESION | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
G6019 | Colonoscopy lesion removal | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44404 | PR COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
44407 | PR COLONOSCOPY STOMA W/US GID NDL ASPIR/BX | HCPCS | 07/12/2012: Policy reviewed; no changes to policy statement. Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. |
45379 | Removal of foreign bodies in large bowel using a flexible endoscope | HCPCS | Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. SOURCE(S)Hayes Medical Technology Directory
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Guidelines for Clinical Applications by the ASGE; Publication Nos. |
0067T | Ct Colonography;Dx | HCPCS | Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. SOURCE(S)Hayes Medical Technology Directory
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Guidelines for Clinical Applications by the ASGE; Publication Nos. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. SOURCE(S)Hayes Medical Technology Directory
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Guidelines for Clinical Applications by the ASGE; Publication Nos. |
45333 | SIG.SCOPE W HOT BX RMV | HCPCS | Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. SOURCE(S)Hayes Medical Technology Directory
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Guidelines for Clinical Applications by the ASGE; Publication Nos. |
45388 | PR COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES | HCPCS | Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. SOURCE(S)Hayes Medical Technology Directory
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Guidelines for Clinical Applications by the ASGE; Publication Nos. |
45389 | PR COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT | HCPCS | Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. SOURCE(S)Hayes Medical Technology Directory
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Guidelines for Clinical Applications by the ASGE; Publication Nos. |
45385 | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | HCPCS | Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. SOURCE(S)Hayes Medical Technology Directory
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Guidelines for Clinical Applications by the ASGE; Publication Nos. |
45393 | PR COLONOSCOPY FLEXIBLE WITH DECOMPRESSION | HCPCS | Removed S0605, 0066T, and 0067T from the Code Reference section as these codes have been deleted. 05/08/2013: Policy reviewed; no changes. 12/31/2014: Code Reference section updated to revise the description of the following CPT codes: 44388, 44390, 44392, 45330, 45332, 45333, 45378, 45379, 45384, and 45385. Effective 1/1/15. Added the following new 2015 CPT codes: 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45346, 45347, 45349, 45350, 45388, 45389, 45390, 45393, 45398, and 45399. Added the following new 2015 HCPCS codes to the Code Reference section: G6019, G6020, G6022, G6023, G6024, G6025. SOURCE(S)Hayes Medical Technology Directory
American Society of Gastroendoscopy (ASGE) consensus statement, "The Appropriate Use of Gastrointestinal Endoscopy"
Guidelines for Clinical Applications by the ASGE; Publication Nos. |
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