This page displays your requested Article. CMS Internet-Only Manual, Publication 100-03 Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, 280.14 Infusion Pumps, CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 23, 20.9 National Correct Coding Innitiative (NCCI). Modifier 22 is used for increased procedural services and demonstrates when a physician has gone above and beyond the typical framework of a particular procedure. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE ("NUBC"), Point and Click American Hospital Association Copyright Notice, Copyright 2021, the American Hospital Association, Chicago, Illinois. Unless specified in the article, services reported under other To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. Draft articles have document IDs that begin with "DA" (e.g., DA12345). If epidural injection (CPT code 62323) is used for an implantable infusion pump trial for severe spasticity, the restrictions in this article do not apply as coverage is determined by NCD 280.14 Infusion Pumps.When the epidural injection (CPT code 62323) is used for cerebrospinal fluid flow imaging, cisternography (CPT code 78630), the diagnosis code restrictions in this article do not apply. 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Complete absence of all Revenue Codes indicates Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. 97811: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles. 2023 Noridian Healthcare Solutions, LLC Terms & Privacy. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). This tool is intended to assist suppliers in determining potential modifiers that may be used in billing DMEPOS HCPCS codes. The patients medical record should include, but is not limited to: The assessment of the patient by the performing provider as it relates to the complaint of the patient for that visit. Amniotic and placenta derived injectants, and platelet rich plasma and vitamins fall in this category. Please click here to see all U.S. Government Rights Provisions. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Draft articles have document IDs that begin with "DA" (e.g., DA12345). You can collapse such groups by clicking on the group header to make navigation easier. Determine the lack of complexity and lack of comorbidities. The insurance carrier denied reimbursement for CPT code 20610-TC, based upon reason code CAC-4-The procedure code is inconsistent with the modifier used or a required modifier is missing. 28 Texas Administrative Code 134.203(b) states For coding, billing, reporting, and reimbursement of CMS DISCLAIMER. If you choose not to accept the agreement, you will return to the Noridian Medicare home page. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. The following links are intended to facilitate documentation and coding diagnoses and services that are provided to patients with Humana coverage: *. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Due to system changes the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added. You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, Billing and Coding: Epidural Steroid Injections for Pain Management, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Epidural Steroid Injections for Pain Management L38994, Article - Billing and Coding: Epidural Steroid Injections for Pain Management (A58695). Under Article Text revised verbiage regarding physician use of modifier 50 when services are performed in an ASC, and added language regarding the use of moderate or deep sedation, general anesthesia, and monitored anesthesia (MAC). When epidural injections (62321, 62323, 64479, 64480, 64483 or 64484) are used for postoperative pain management, the diagnosis code restrictions in this article do not apply. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. All rights reserved. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Copyright © 2022, the American Hospital Association, Chicago, Illinois. "1" indicates modifier 50 can be appropriate. All Rights Reserved. Draft articles are articles written in support of a Proposed LCD. Please refer to the LCD for reasonable and necessary requirements.The services addressed in this article only apply to epidural injections. Some articles contain a large number of codes. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Medicare and Medicaid require a minimum time period for billing a treatment session. There are multiple ways to create a PDF of a document that you are currently viewing. article does not apply to that Bill Type. Humana guidelines and best practices. an effective method to share Articles that Medicare contractors develop. While every effort has been made to provide accurate and If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. Medicare rules differ from the instructions in U5. ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, L38994 - Epidural Steroid Injections for Pain Management, INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT), INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT), INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC, SINGLE LEVEL, INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, SINGLE LEVEL, INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE, INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITHOUT IMAGING GUIDANCE, BILATERAL PROCEDURE: UNLESS OTHERWISE IDENTIFIED IN THE LISTINGS, BILATERAL PROCEDURES THAT ARE PERFORMED AT THE SAME OPERATIVE SESSION SHOULD BE IDENTIFIED BY ADDING THE MODIFIER -50 TO THE APPROPRIATE FIVE DIGIT CODE OR BY USE OF THE SEPARATE FIVE DIGIT MODIFIER CODE 09950, REQUIREMENTS SPECIFIED IN THE MEDICAL POLICY HAVE BEEN MET, LEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE LEFT SIDE OF THE BODY), RIGHT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE RIGHT SIDE OF THE BODY), Other spondylosis with radiculopathy, cervical region, Other spondylosis with radiculopathy, cervicothoracic region, Other spondylosis with radiculopathy, thoracic region, Other spondylosis with radiculopathy, thoracolumbar region, Other spondylosis with radiculopathy, lumbar region, Other spondylosis with radiculopathy, lumbosacral region, Spinal stenosis, lumbar region with neurogenic claudication, Cervical disc disorder at C4-C5 level with radiculopathy, Cervical disc disorder at C5-C6 level with radiculopathy, Cervical disc disorder at C6-C7 level with radiculopathy, Cervical disc disorder with radiculopathy, cervicothoracic region, Intervertebral disc disorders with radiculopathy, thoracic region, Intervertebral disc disorders with radiculopathy, thoracolumbar region, Intervertebral disc disorders with radiculopathy, lumbar region, Intervertebral disc disorders with radiculopathy, lumbosacral region, Radiculopathy, sacral and sacrococcygeal region, Postlaminectomy syndrome, not elsewhere classified, Subluxation stenosis of neural canal of cervical region, Subluxation stenosis of neural canal of thoracic region, Subluxation stenosis of neural canal of lumbar region, Osseous stenosis of neural canal of cervical region, Osseous stenosis of neural canal of thoracic region, Osseous stenosis of neural canal of lumbar region, Connective tissue stenosis of neural canal of cervical region, Connective tissue stenosis of neural canal of thoracic region, Connective tissue stenosis of neural canal of lumbar region, Intervertebral disc stenosis of neural canal of cervical region, Intervertebral disc stenosis of neural canal of thoracic region, Intervertebral disc stenosis of neural canal of lumbar region, Osseous and subluxation stenosis of intervertebral foramina of cervical region, Osseous and subluxation stenosis of intervertebral foramina of thoracic region, Osseous and subluxation stenosis of intervertebral foramina of lumbar region, Connective tissue and disc stenosis of intervertebral foramina of cervical region, Connective tissue and disc stenosis of intervertebral foramina of thoracic region, Connective tissue and disc stenosis of intervertebral foramina of lumbar region, Some older versions have been archived. , with re-insertion of needles, Chicago, Illinois to make navigation easier use of CDT limited! 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