Aetna policy on cpt 76830. Medical Coverage Policy: 0398 .

Aetna policy on cpt 76830 0 Clinical Payment and Coding Policy Committee Approval Date: February 24, 2022 Effective Date: March 7, 2022 Description This Clinical Payment and Coding Policy is intended to serve as a reference for facilities and providers (physicians CPT code 76830 represents a non-obstetrical transvaginal ultrasound. Experimental, Investigational, or Unproven. This Clinical Policy Bulletin addresses chronic vertigo. Note: Minor synovectomy (CPT code 29875) is considered integral to all other arthroscopic procedures of the knee. This Clinical Policy Bulletin addresses invasive procedures for back pain. Claims will be denied as not medically necessary for all customers if the diagnosis and procedure codes billed do not align with covered services defined by the policy. Description The uterus, fallopian tubes, ovaries, cervix, and vagina are examined by Transvaginal ultrasonography in female patients. CPT code 76830, a medical procedure code for Diagnostic Ultrasound Procedures of the Pelvis Non-Obstetrical, is still used by the American Medical Association. The investigators reported that there was a significant prolongation of the time to progression of disease in the high-dose-antibody group as compared with the placebo group (hazard ratio [HR], 2. Experimental, Investigational, or Unproven Policy Scope of Policy. 0 - I74. This Clinical Policy Bulletin addresses endometrial ablation. Modifier 59 will not override these edits. Documentation for ultrasound coding 76830 Regarding billing code 76830: it “includes imaging of the uterus, endometrium, fallopian tubes, ovaries, and pelvic structures such as the bladder, as indicated. This Clinical Policy Bulletin addresses transcervical balloon tuboplasty. This Clinical Policy Bulletin addresses single photon emission computed tomography (SPECT). , intellectual disability, developmental delay, and severe behavioral disorders). Aetna considers in-office and in-hospital antepartum fetal surveillance with non-stress tests (NST), contraction stress tests (CST), biophysical profile (BPP), modified BPP, and umbilical artery and middle cerebral Doppler velocimetry medically necessary according to the American Applicable CPT / HCPCS / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met: 0167U: Gonadotropin, chorionic (hCG), immunoassay with direct optical observation, blood: 0353U CPT Codes / HCPCS Codes / ICD-10 Codes ; Code Code Description; Ultrasonic guidance for needle placement: CPT codes covered if selection criteria are met: 76942: Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation: 76998: Ultrasonic guidance, intraoperative Policy Scope of Policy. Therefore, transvaginal ultrasound (CPT® 76830) and pelvic ultrasound (CPT® 76856 or CPT® 76857) are not supported for those with a positive pregnancy test or known pregnancy. This Clinical Policy Bulletin addresses occupational therapy. Aetna considers the following interventions experimental, investigational, or unproven for treating low back pain (LBP) or other indications because the effectiveness of these approaches has not been established: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Intravenous and Subcutaneous Immunoglobulins: CPT codes covered if selection criteria are met: 90283: Immune globulin (IgIV), human, for intravenous use: 90284: Immune globulin (SCIg), human, for use in subcutaneous infusions, 100 mg, each: Other CPT codes related to the CPB: 0537T Policy Scope of Policy. This Clinical Policy Bulletin addresses inclisiran (Leqvio) for commercial medical plans. This Clinical Policy Bulletin addresses hyperbaric oxygen therapy. g Policy Scope of Policy. Aetna considers the following experimental, investigational, or unproven because their safety and effectiveness in improving outcomes has not been established: Aetna considers a Food and Drug Administration (FDA)-approved ventricular assist device (VAD) medically necessary for any of the following FDA-approved indications: As a bridge to transplant for members who are awaiting heart transplantation (see CPB 0586 - Heart Transplantation ) and the device has received FDA approval for a bridge to Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Aetna considers scrotal ultrasonography medically necessary for any of the following conditions: Detection and characterization of scrotal mass lesions/tumors; or; Detection of undescended (cryptorchid) testes in either of the following: CPT code 76830 is used to describe a transvaginal ultrasound procedure that is performed for non-obstetric purposes. This Clinical Policy Bulletin addresses stereolithographic models and implants. This Clinical Policy Bulletin addresses screening for lipid disorders. Aetna considers automated ambulatory blood pressure monitoring medically necessary according to the selection criteria listed below, which are based, in part, on guidelines developed by the American College of Physicians. , adenomyosis, cancer, cyst, and fibroid); Diagnosis of bowel endometriosis; Follow-up ultrasound performed after a detailed anatomic ultrasound (CPT code 76811), should be reported as CPT 76816 (Ultrasound, pregnant uterus, real time with image documentation, follow-up) (SMFM, 2012). Experimental, Investigational, or Unproven Per American Medical Association definitions of CR CPT codes, sessions may be with ECG-monitoring (93798) or without ECGmonitoring (93797) (CPT Manual). • It is important to note that there is only a complete exam code for transvaginal ultrasound. CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Ozurdex: CPT codes covered if selection criteria are met: 67027: Implantation of intravitreal drug delivery system (eg, ganciclovir implant), includes concomitant removal of vitreous: 67028: Intravitreal injection of a pharmacologic agent (separate procedure) Other CPT codes related Table: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met:: 37241: Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations Policy Scope of Policy. Background. Aetna considers systemic hyperbaric oxygen therapy (HBOT) medically necessary for any of the following conditions (with usual medically necessary number of sessions (dives) in parentheses): Acute air or gas embolism (up to 10 sessions); Policy Scope of Policy. Detection and diagnosis. Aetna considers radiofrequency ablation medically necessary for the treatment of members with Barrett's esophagus (BE) who have histological confirmation of low-grade dysplasia (LGD) by 2 or more endoscopies 3 or more months apart. Aetna considers AAA screening experimental, investigational, or unproven for all other indications because its effectiveness for indications other than the one listed above has not been established. Aetna considers physical therapy (PT) medically necessary when this care is prescribed by a chiropractor, DO, MD, nurse practitioner, podiatrist or other health professional qualified to prescribe physical therapy according to State law in order to significantly improve, develop or restore I just posted this question to local forum and reposting it here with hopes of any input; We are getting denials from Aetna for 76856 Pelvic ultrasound - trans-abdominal when billing with 76830 ultrasound trans-vaginal. This Clinical Policy Bulletin addresses automated ambulatory blood pressure monitoring. Aetna is updating and adding effective August 1, 2021 based on the NCCI policy. This Clinical Policy Bulletin addresses viscocanalostomy and canaloplasty. 40 to placebo, 37 to low-dose bevacizumab, and; 39 to high-dose bevacizumab. A pelvic ultrasound (CPT code *76856 or *76857) typically evaluates the same organs and represents a redundancy in services. Aetna considers ocular photo-screening medically necessary for screening of pre-verbal children up to 5 years of age, and children or adolescents who are non-cooperative or non-verbal (e. Aetna considers electromagnetic navigation (EN)-guided bronchoscopy medically necessary for individuals with a peripheral pulmonary nodule that requires a pathologic diagnosis and is not accessible by standard bronchoscopy methods or by a transthoracic biopsy approach. This Clinical Policy Bulletin addresses electromagnetic navigation-guided bronchoscopy. This Clinical Policy Bulletin addresses brain natriuretic peptide testing. Aetna considers any of the following injections or procedure medically necessary for the treatment of back pain; provided that only one invasive modality or procedure will be considered medically necessary at a time. Aetna considers the following interventions medically necessary: Fetal echocardiograms, Doppler and color flow mapping after 12 weeks gestation for any of the following conditions: 5 days ago · tci Part B Insider - 2006 Issue 13 RADIOLOGY: Learn How To Bill For Pelvic And Transvaginal Ultrasounds On Same Day. 99: Pulmonary embolism : I74. 9: Arterial embolism and thrombosis [unexplained thrombotic disorders A transvaginal ultrasound (CPT code *76830) is a diagnostic test providing a look at the female reproductive organs. 11: Homocystinuria : I26. This Clinical Policy Bulletin addresses deep brain stimulation. 5. Aetna considers autonomic testing such as quantitative sudomotor axon reflex test (QSART), silastic sweat imprint, and thermoregulatory sweat test (TST) medically necessary for use as a diagnostic tool for any of the following conditions/disorders: Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin addresses ambulatory electroencephalography. Limited exam is included in complete one, hence it should not be reported separately. 73) • DXA bone density studies (77080 or 77081) will be denied when the only diagnosis Oct 25, 2010 · Now, there are two codes depending on the pregnancy status. That is why we are happy to tell you Jun 3, 2020 · OB/GYN-New York Aetna is denying cpt code 76856 when bill with 76830 (modifiers are used) stating 76856 is incidental to primary procedure Ultrasound Aetna ® Better Health of Kansas 9401 Indian Creek Parkway, Suite 1300 Overland Park, KS 66210 January 11, 2021 Aetna Better Health® of Kansas Clinical Payment, Coding and Policy Changes We regularly augment our clinical, payment and coding policy positions as part of our ongoing policy review processes. This Clinical Policy Bulletin addresses antepartum fetal surveillance. The uterus, tubes and Table: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met:: 61534: Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery Aetna considers the following interventions medically necessary: Percutaneous mitral valve repair (PMVR) by means of the MitraClip Clip Delivery System for persons with grade 3+ to 4+ symptomatic degenerative mitral regurgitation and at high-risk for traditional open-heart mitral valve surgery; Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. No. Aetna considers multi-channel urodynamic studies medically necessary when the member has both symptoms and physical findings of urinary incontinence/voiding dysfunctions (such as stress incontinence, overactive bladder, lower urinary tract symptoms) and there is consideration by the CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Information in the [brackets] below has been added for clarification purposes. Depression in primary care. Aetna considers ambulatory electroencephalography (EEG) with or without home video monitoring medically necessary for any of the following conditions, where the member has had a recent (within the past 12 months) neurologic examination and standard EEG studies Footnote *: Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin addresses tubal sterilization. Aetna Aug 1, 2024 · The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. • If the patient is pregnant use the code (76817). CPT codes not covered for indications listed in the CPB : 0720T: Percutaneous electrical nerve field stimulation, cranial nerves, without implantation: Scrambler Therapy/Calmare Therapy Device: CPT codes not covered for indications listed in the CPB (not all-inclusive): 0278T Table: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met:: 19296: Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy Aetna considers continuous passive motion (CPM) machines medically necessary durable medical equipment (DME) to improve range of motion in any of the following circumstances: During the post-operative rehabilitation period for members who have received a total knee arthroplasty (TKA) or revision TKA as an adjunct to ongoing physical therapy (PT Policy Scope of Policy. Codes requiring a 7th character are represented by "+": CPT codes covered if selection criteria are met: 36465 - 36466 Policy Scope of Policy. This Clinical Policy Bulletin addresses ocular photo-screening. Caloric vestibular testing; Dynamic or head shaking acuity testing Policy Scope of Policy. Aetna considers videostroboscopy medically necessary as a diagnostic procedure for detection of vocal cord pathology (e. During the course of an office visit, if a provider performs a pelvic ultrasound and determines that the image is unclear and that a transvaginal ultrasound is necessary, only the transvaginal CPT Knowledgebase - Oct 27, 2023 During a transvaginal (TV) ultrasound examination (76830) and a transabdominal (TA) ultrasound examination (76856) of the pelvis, the TA examination mentions only the uterus and its measurements; however, the TV examination documents the endometrium, both the ovaries, and their measurements. Aetna considers transrectal ultrasound (TRUS) medically necessary for any of the specific conditions involving the prostate, rectum and surrounding tissues listed below: For prostate biopsy in men, see CPB 0698 - Prostate Saturation Biopsy; or Table: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met:: 37252: Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Depo-Provera (injectable medroxyprogesterone acetate): Other CPT codes related to the CPB: 96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular : HCPCS codes covered if selection criteria are met: J1050 Dec 28, 2017 · AETNA BETTER HEALTH® OF KENTUCKY Change to provider processes PROVIDER FAX BLAST – DECEMBER 28, 2017 – PAGE 1 OF 9 To: Network Providers Fax: <<location fax>> RE: Provider Process Changes for PA Requirements Your partnership with Aetna Better Health of Kentucky (Aetna) is important. This Clinical Policy Bulletin addresses physical therapy. , Harmony Transcatheter Pulmonary Valve (TPV) System, Melody Transcatheter Pulmonary Valve, and Sapien S3 Valve) medically necessary for the following indications: Table: CPT Codes / HCPCS Codes / ICD-10 Codes ; Code Code Description; CPT codes covered if selection criteria are met:: 37243: Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction [covered for treatment of CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met: Drug-coated balloon angioplasty –no specific code: 37220 - 37247: Revascularization, endovascular: CPT codes not covered for indications listed in the CPB: 0234T Policy Scope of Policy. AHCPR Clinical Practice Guideline No. Stem Cells. This Clinical Policy Bulletin addresses scrotal ultrasonography. 9: Sepsis Policy Scope of Policy. This Clinical Policy Bulletin addresses transrectal ultrasound. This Clinical Policy Bulletin addresses risankizumab-rzaa (Skyrizi) for commercial medical plans. Aetna ® Better Health of Kansas 9401 Indian Creek Parkway, Suite 1300 Overland Park, KS 66210 September 24, 2021 Aetna Better Health® of Kansas Clinical Payment, Coding and Policy Changes We regularly augment our clinical, payment and coding policy positions as part of our ongoing policy review processes. , polyps, invasive carcinoma, and vocal cord paresis and paralysis) in members who have received both a mirror-image and an endoscopic examination, and in whom no abnormal Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. g. , Pomeroy technique (tubal ligation), and Parkland technique) Table: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met:: 33946: Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-venous Table: Applicable CPT / HCPCS / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met:: 11920 : Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6. , neurofibromatosis or von Recklinghausen's disease) or bilateral surgical removal of auditory nerve tumors is planned and is expected to result in complete bilateral deafness. This Clinical Policy Bulletin addresses romosozumab-aqqg (Evenity) for commercial medical plans. Both procedure codes are reimbursed by Medicare at the same rate in a hospital outpatient setting" (AACVPR, 2024). a) When 76830 is billed in conjunction with 76856, to indicate that both trans-abdominal and transvaginal examinations were conducted at the same visit in order to establish complete visualization of the pelvic anatomy, the payment for the 76830 will be reduced by 50% to reflect its status as a secondary procedure. Aetna considers manipulation under general anesthesia (MUA) medically necessary for the following indications: Arthrofibrosis of knee following total knee arthroplasty, knee surgery, or fracture (see Appendix); or CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met: 00104: Anesthesia for electroconvulsive therapy: 90870: Electroconvulsive therapy (includes necessary monitoring) [not covered for ultrabrief bilateral electroconvulsive therapy] CPT codes not covered for indications listed in the CPB CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Diagnosis: CPT codes covered if selection criteria are met: 42975: Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic: 95808 CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Diagnosis: CPT codes covered if selection criteria are met: 42975: Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic: 95808 Aug 18, 2014 · CPT ® codes 97810, 97811, 97813, and 97814 will have a specific set of diagnosis codes that will be covered when billed together. The Correct Coding Initiative deleted an edit that bundled CPT 76830 Medical Coverage Policy: 0398 . Carriers seek documentation that supports both exams on same dateYour carrier may not be up to date on the latest coding rules if it's denying transvaginal ultrasounds on the same date as pelvic ultrasounds. CPT codes covered if selection criteria are met: 83090: Homocysteine: CPT codes not covered for indications listed in the CPB: 83695: Lipoprotein (a) ICD-10 codes covered if selection criteria are met: E72. Follow-up scan (76816) for low risk pregnancies: The program will allow one repeat or follow-up ultrasound for low-risk pregnancies if the first ultrasound proves inadequate to evaluate fetal anatomy as documented in the patient’s medical record. View the Answer Policy Scope of Policy. Jan 20, 2001 · • Transvaginal ultrasound (76830) will be denied when the only diagnosis on the claim is encounter for ovarian cancer screening (ICD-10 code Z12. Do use X{EPSU} modifier while coding CPT code Policy Scope of Policy. Aetna considers autologous chondrocyte implants medically necessary for repairing cartilage defects of the knee in members who have symptoms of disabling knee pain related to a full thickness, focal chondral defect with all of the following: Aetna considers pulse oximetry and capnography for home use medically necessary for following: Pulse oximeter for home use as durable medical equipment (DME) for members with chronic lung disease, severe cardiopulmonary disease or neuromuscular disease involving muscles of respiration, and any of the following indications: Applicable CPT / HCPCS / ICD-10 Codes; Code Code Description; Information in the [brackets] below has been added for clarification purposes. Rockville, MD: AHCPR; April 1993. Feb 26, 2018 · Your information could include a keyword or topic you're interested in; a Local Coverage Determination (LCD) policy or Article ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code. , pigmented villonodular synovitis, synovial osteochondromatosis) is identified pre-operatively. Sep 25, 2012 · Aetna is delaying this policy from September 1, 2011 to December 1, 2012. The following procedure codes will no longer be considered diagnostic in nature, but as surgical services. Aetna considers transrectal ultrasound (TRUS) medically necessary for any of the specific conditions involving the prostate, rectum and surrounding tissues listed below: For prostate biopsy in men, see CPB 0698 - Prostate Saturation Biopsy; or Policy Scope of Policy. Jul 4, 2019 · Your information could include a keyword or topic you're interested in; a Local Coverage Determination (LCD) policy or Article ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code. Aetna considers canaloplasty medically necessary for the treatment of primary open-angle glaucoma (POAG), including normal-tension glaucoma, and for pseudo-exfoliation glaucoma. 0 - A41. CPT codes covered if selection criteria are met: Sepsis pathogen panel - no specific code: Other CPT codes related to the CPB: 87040: Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) ICD-10 codes covered if selection criteria are met: A40. Jan 1, 2025 · Enter your keyword or 4-digit CPB number (for example, enter 0059 to find CPB 59) to find related medical clinical policy bulletins. There are no CCI edits for this pair of codes. Policy above is adapted from eviCore imaging guidelines. This Clinical Policy Bulletin addresses Barrett's esophagus. Does CPT 93976 need a modifier? Do not code complete ultrasound CPT code 76770 & limited CPT code 76775 together. This Clinical Policy Bulletin addresses urinary incontinence. CPT 2020 states that “Mastectomy procedures (with the exception of gynecomastia [19300]) are performed either for treatment or prevention of breast Policy Scope of Policy. Note on Definition of Intensity Modulated Radiation Therapy (IMRT): For purposes of this policy, to qualify as IMRT, radiation therapy requires highly sophisticated treatment planning utilizing numerous beamlets to generate dosimtery in accordance with assigned dose requirements to the tumor and organs at risk. Policy Scope of Policy . References to CPT or other sources are for definitional purposes only and do CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Other CPT codes related to the CPB: 96401 - 96450: Chemotherapy administration: 96446: Chemotherapy administration into the peritoneal cavity via indwelling port or catheter [pressurized intra-peritoneal aerosol chemotherapy (PIPAC)] HCPCS codes covered if selection criteria are met Policy Scope of Policy. Medical Necessity. The Current Procedural Terminology (CPT) Code for this procedure is: 6. Feb 5, 2023 · Community Plan reimbursement policies uses Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. This Clinical Policy Bulletin addresses videostroboscopy. Aetna considers transcervical balloon tuboplasty medically necessary for members with infertility due to a proximal tubal occlusion demonstrated on hysterosalpingogram. Nov 1, 1999 · One option for Stout and others like her is to code for the transvaginal ultrasound using CPT Code 76830 and apply a -22 modifier (unusual procedural services) although there are some questions about using the modifier. There was a small difference, of borderline significance, between The above policy is based on the following references: Agency for Healthcare Policy and Research (AHCPR), Depression Guideline Panel. 76817, Ultrasound, pregnant uterus, real time with image documentation, transvaginal. AHCPR Pub. Aetna considers the following procedures medically necessary for tubal ligation sterilization: Falope ring; Filshie clip (titanium clip) Hulka-Clemens clip; Partial salpingectomy (e. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Oct 1, 2024 · Transvaginal ultrasonography (TVU), also referred to as endovaginal ultrasonography, is a pelvic and lower abdominal imaging procedure and type of pelvic ultrasound technique which uses a thin transducer (endocavitary ultrasound probe) covered with acoustic conducting gel and a protective sheath (often plastic or latex) that produces diagnostic anatomic images when introduced through the Policy Scope of Policy. Non-Cardiac Indications. A -22 modifier will cause the claim to pendthe claim will get noticed by a reviewer. 93-0550. If a pregnancy test is positive, then obstetrical CPT codes are indicated. S. Aetna considers the following medically necessary: Endometrial ablation for women who meet all of the following selection criteria: Menorrhagia Footnote1 * unresponsive to (or with a contraindication to) either: Dilation and curettage; or The above policy is based on the following references: Adamson JW. This Clinical Policy Bulletin addresses autologous chondrocyte implantation. Aetna considers the following procedures as medically necessary (unless otherwise specified) for chronic vertigo: Diagnosis and Evaluation of Chronic Vertigo or Ménière's Disease. 08/18/2014; Bone Growth Stimulators May 10, 2021 · The NCCI is a collection of bundling edits created and sponsored by the Centers for Medicare & Medicaid Services (CMS). Aetna considers nutritional counseling a medically necessary preventive service for children and adults who are obese, and for adults who are overweight and have other cardiovascular disease risk factors (hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome CPT codes covered if selection criteria are met: 37236 Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and Feb 12, 2024 · The use of gynecology CPT codes for pregnant females is not supported. This Clinical Policy Bulletin addresses orthopedic casts, braces, and splints. Aetna considers single photon emission computed tomography (SPECT) medically necessary for any of the following indications: Policy Scope of Policy. 33: Obstructive sleep apnea (adult) (pediatric) Elevoplasty (the Elevo Palatal Implant System): CPT codes not covered for indications listed in the CPB: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered when selection criteria are met: 36514: Therapeutic apheresis; for plasma pheresis [not covered for chronic or secondary progressive MS (maintenance therapy)] CPT codes not covered for indications listed in the CPB: Policy Scope of Policy. Note: Requires Precertification: Precertification of romosozumab-aqqg (Evenity) is required of all Aetna participating providers and members in applicable plan designs. Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered. This Clinical Policy Bulletin addresses influenza vaccine. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Table: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Tumor Scintigraphy:: CPT codes covered if selection criteria are met for ProstaScint, Oncoscint, CEA-Scan, Technetium-99m-Sestamibi Scintigraphy, OctreoScan, Radiolabeled Octreotide, Meta-Iodobenzylguanidine (MIBG), and Breast Specific Gamma imaging: Background. • If the patient is NOT pregnant use the code (76830). Codes 20930 and 20936 will be disallowed when billed with another CPT and/or HCPCS procedure code. This Clinical Policy Bulletin addresses fetal echocardiography and magnetocardiography. When billing, providers must use the most appropriate codes as of the effective date of the submission. 01 - I26. Aetna considers the following orthopedic casts, braces and splints medically necessary (unless otherwise stated) for the listed indications when they are used to treat disease or injury: The Current Procedural Terminology (CPT ®) code 76830 as maintained by American Medical Association, is a medical procedural code under the range - Diagnostic Ultrasound Procedures of the Pelvis Non-Obstetrical. Volume 1. Major synovectomy (CPT code 29876) is only considered medically necessary when a disease of the synovium (e. Please note that the information below sets forth the anticipated schedule for review of the specified Clinical Policy Bulletin (CPB) in the ordinary course. 0 sq cm or less Precertification of bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta, and bendamustine) is required of all Aetna participating providers and members in applicable plan designs. CPT Code 76817 may be billed alone or with other ultrasound services at the same session. CPT Codes / HCPCS Codes / ICD-10 Codes ; Code Code Description; CPT codes covered if selection criteria are met: 61635: Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed: Other CPT codes related to the CPB: 0639T Provider manual Resources, policies and procedures at your fingertips Aetna. Food and Drug Administration (FDA)-approved influenza vaccines medically necessary according to the recommendations of the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP): 1 day ago · CPT&reg; Code 76830 in section: Diagnostic Ultrasound Procedures of the Pelvis Non-Obstetrical Feb 1, 2024 · The use of gynecology CPT codes for pregnant women is not supported. Codes requiring a 7th character are represented by "+": CPT codes covered when selection criteria are met: 33361 Aetna's HMO policy is similar to Medicare policy on routine foot care, in that Medicare also does not cover: cutting or removal of corns and calluses; clipping or trimming of normal or mycotic nails; shaving, paring, cutting or removal of keratoma, tyloma, and heloma; non-definitive simple, palliative treatments like shaving or paring of The CPT codes for mastectomy (CPT codes 19303) are for breast cancer, and are not appropriate to bill for reduction mammaplasty for female to male (transmasculine) gender affirmation surgery. Positron emission tomography (PET) also known as positron emission transverse tomography (PETT), or positron emission coincident imaging (PECI), is a non-invasive diagnostic imaging procedure that assesses the level of metabolic activity and perfusion in various organ systems of the human body. This Clinical Policy Bulletin addresses transcatheter pulmonary valve implantation. This Clinical Policy Bulletin addresses nutritional counseling. Non-ob scenario. Aetna considers magnetic resonance imaging (MRI) medically necessary for appropriate indications without regard to the field strength or configuration of the MRI unit. This means the ultrasound is conducted via the vagina to examine the pelvic organs, such as the uterus, ovaries, and other structures, but it is not related to pregnancy. , stimulation of the ventral intermediate thalamic nucleus, globus pallidus, and subthalamic nucleus) medically necessary durable medical equipment (DME) for the treatment of intractable tremors as a consequence of Aetna considers total body plethysmography medically necessary as an adjunct to complete pulmonary function testing (including residual volumes and diffusion) for any of the following indications: For determination of bronchial hyper-reactivity in response to methacholine, histamine, or isocapnic hyperventilation; or Policy Scope of Policy. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). This Clinical Policy Bulletin addresses manipulation under general anesthesia. Note: Requires Precertification: Precertification of inclisiran (Leqvio) is required of all Aetna participating providers and members in applicable plan designs. 55; p < 0. For precertification of bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta, and bendamustine), call (866) 752-7021 or fax (888) 267-3277. Aetna considers transvaginal ultrasonography (TV-US) medically necessary for a number of indications: Assessment of a pelvic mass (e. Jan 25, 2021 · What does CPT code 76830 mean? CPT code 76830 represents a non-obstetrical transvaginal ultrasound. Note: Requires Precertification: Precertification of intravenous risankizumab-rzaa (Skyrizi) is required of all Aetna participating providers and members in applicable . This Clinical Policy Bulletin addresses lumbar traction devices. Aetna considers occupational therapy (OT) medically necessary for the following indications, unless otherwise specified: Short-term OT in selected cases when this care is prescribed by a physician, and the following criteria are met: Applicable CPT / HCPCS / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met: Single anastomosis duodenal-ileal switch (SADI-S) - no specific code: 43644: Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux Limb 150 cm or less) 43645 CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Leuprolide acetate: Other CPT codes related to the CPB: 96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular: HCPCS codes covered if selection criteria are met: J9218: Leuprolide acetate, per 1 mg: J9219: Leuprolide CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; Octreotide (Sandostatin, Sandostatin LAR Depot): Other CPT codes related to the CPB: 33615: Repair of complex cardiac anomalies (e. covered under this Coverage Policy (see “Coding Information” below). This Clinical Policy Bulletin addresses open air, low field strength, and positional magnetic resonance imaging (MRI) units. This Clinical Policy Bulletin addresses drug testing in pain management and substance use disorder treatment. CCI edits are for services performed by the same provider on the same date of service only. 1997;15(Suppl 1):57-61. Policy Applicable CPT / HCPCS / ICD-10 Codes Background References Brand Selection for Medically Necessary Indications for Commercial Medical Plans As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent Other CPT codes related to the CPB: 93318 Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis Policy Scope of Policy. , tricuspid atresia) by closure of atrial septal defect and anastamosis of atria or vena cava to pulmonary artery (simple Fontan procedure) 33617 CPT codes not covered for indications listed in the CPB: 31420: Epiglottidectomy: ICD-10 codes not covered for indications listed in the CPB: G47. This Clinical Policy Bulletin addresses autonomic tests and sudomotor tests. Agency for Healthcare Policy and Research (AHCPR). Aetna considers the following medically necessary: Directly measured low-density lipoprotein cholesterol (LDL-C) in persons with triglyceride levels greater than 250 mg/dL and in persons with type 2 diabetes CPT codes not covered for indications listed in the CPB: 83520: Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified [as a screening for the early detection of lung cancer] EarlyTect Bladder Cancer Detection test: CPT codes not covered for indications listed in the CPB Aetna considers an auditory brainstem implant (ABI) medically necessary in members 12 years of age or older who have lost both auditory nerves due to disease (e. Aetna considers the following U. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Table: CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; HCPCS codes covered if selection criteria are met:: A5500 - A5507, A5510 - A5514 Aetna considers one-time ultrasound screening for abdominal aortic aneurysms (AAA) medically necessary for men 65 years of age or older. com 3302205-01-01 (4/24) Policy Scope of Policy. Policy Scope of Policy. Aetna considers measurement of plasma brain natriuretic peptide (BNP) medically necessary for the following indications: To differentiate dyspnea due to heart failure from pulmonary disease; or Table: CPT Codes / HCPCS Codes / ICD-10 Codes ; Code Code Description; CPT codes covered for indications listed in the CPB:: 0795T: Transcatheter insertion of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming Point-of-Care Ultrasound Examination Policy Policy Number: CPCP030 Version 1. 001). It is not uncommon to see codes for the pelvic region in radiology, including ovarian Policy Scope of Policy. Aetna considers the following medically necessary: Endometrial biopsy (sampling) for histological tissue examination in the diagnostic evaluation of abnormal uterine bleeding in women suspected of having endometrial hyperplasia or endometrial carcinoma; and for endometrial cancer surveillance in women with Lynch syndrome. For Medicare criteria, see Medicare Part B Criteria. Aetna considers transcatheter pulmonary valve implantation using FDA-approved devices (e. Note: This CPB does not address therapeutic drug monitoring, drug testing in the emergency room, or monitoring of persons prescribed drugs with abuse potential that are prescribed outside of a pain management program or substance use disorder program (e. Cord blood stem cell banking and transplantation. CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met: + 93325: Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) Other CPT codes related to the CPB [parent codes for 93325]: 33615 Jun 1, 2013 · The optimal method for cervical screening is TVU. Aetna considers unilateral or bilateral deep brain stimulators (e. ccberdy oqj flw qjuohkj dorfv rhchkq nmyjt eheyt jcclest swrqm