Local Coverage Article Billing and Coding

Billing and Coding: Peroral Endoscopic Myotomy (POEM)

A58287

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Contractor Information

Article Information

General Information

Article ID
A58287
Article Title
Billing and Coding: Peroral Endoscopic Myotomy (POEM)
Article Type
Billing and Coding
Original Effective Date
02/28/2021
Revision Effective Date
01/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Peroral Endoscopic Myotomy (POEM) L38747.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

Covered

Group 1 Codes
CodeDescription
43497 LOWER ESOPHAGEAL MYOTOMY, TRANSORAL (IE, PERORAL ENDOSCOPIC MYOTOMY [POEM])

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

Covered

Group 1 Codes
CodeDescription
K22.0 Achalasia of cardia

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2022 R1

Under CPT/HCPCS Codes Group 1: Codes added 43497 and deleted 43499. This revision is due to the 2022 Annual CPT/HCPCS Code Update and is effective on January 1, 2022.

Associated Documents

Related Local Coverage Documents
LCDs
L38747 - Peroral Endoscopic Myotomy (POEM)
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
12/29/2021 01/01/2022 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • POEM
  • Peroral Endoscopic Myotomy