FUTURE LCD Reference Article Billing and Coding Article

Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP)

A58354

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A58354
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP)
Article Type
Billing and Coding
Original Effective Date
02/07/2021
Revision Effective Date
06/02/2024
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

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.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §20 Payment Conditions for Radiology Services 

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §20.9 National Correct Coding Initiative (NCCI) and §30 Services Paid Under the Medicare Physician’s Fee Schedule

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complements the Local Coverage Determination (LCD) for Computed Tomography Cerebral Perfusion Analysis (CTP) L38769.

Documentation Requirements:

The patient's medical record must contain documentation that fully supports the medical necessity for services included within the related LCD (see Coverage Indications, Limitations and/or Medical Necessity). This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. The documentation of the study requires a formal written report, with clear identifying demographics, the name of the interpreting provider, the reason for the tests, an interpretive report and copies of images. The computerized image reconstruction data should also be maintained.

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
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CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

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Group 1 Codes
Code Description
0042T CEREBRAL PERFUSION ANALYSIS USING COMPUTED TOMOGRAPHY WITH CONTRAST ADMINISTRATION, INCLUDING POST-PROCESSING OF PARAMETRIC MAPS WITH DETERMINATION OF CEREBRAL BLOOD FLOW, CEREBRAL BLOOD VOLUME, AND MEAN TRANSIT TIME
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(53 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
G43.401 Hemiplegic migraine, not intractable, with status migrainosus
G43.409 Hemiplegic migraine, not intractable, without status migrainosus
G43.411 Hemiplegic migraine, intractable, with status migrainosus
G43.419 Hemiplegic migraine, intractable, without status migrainosus
G45.1 Carotid artery syndrome (hemispheric)
G46.0 Middle cerebral artery syndrome
G81.01 Flaccid hemiplegia affecting right dominant side
G81.02 Flaccid hemiplegia affecting left dominant side
G81.03 Flaccid hemiplegia affecting right nondominant side
G81.04 Flaccid hemiplegia affecting left nondominant side
G81.91 Hemiplegia, unspecified affecting right dominant side
G81.92 Hemiplegia, unspecified affecting left dominant side
G81.93 Hemiplegia, unspecified affecting right nondominant side
G81.94 Hemiplegia, unspecified affecting left nondominant side
G83.84 Todd's paralysis (postepileptic)
H53.131 Sudden visual loss, right eye
H53.132 Sudden visual loss, left eye
H53.133 Sudden visual loss, bilateral
H53.139 Sudden visual loss, unspecified eye
H53.8 Other visual disturbances
H53.9 Unspecified visual disturbance
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I69.320 Aphasia following cerebral infarction
I69.321 Dysphasia following cerebral infarction
I69.322 Dysarthria following cerebral infarction
I69.323 Fluency disorder following cerebral infarction
I69.351 Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side
I69.352 Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side
I69.353 Hemiplegia and hemiparesis following cerebral infarction affecting right non-dominant side
I69.354 Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side
R26.0 Ataxic gait
R26.2 Difficulty in walking, not elsewhere classified
R27.8 Other lack of coordination
R27.9 Unspecified lack of coordination
R29.810 Facial weakness
R41.4 Neurologic neglect syndrome
R47.01 Aphasia
R47.02 Dysphasia
R47.1 Dysarthria and anarthria
R47.81 Slurred speech
R47.89 Other speech disturbances
R47.9 Unspecified speech disturbances
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

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Group 1 Codes

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Additional ICD-10 Information

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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.

Code Description
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.

Code Description
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
06/02/2024 R2

The related Computed Tomography Cerebral Perfusion Analysis (CTP) L38769 LCD is being presented for notice. Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes G43.401, G43.409, G43.411, G43.419, G45.1, G46.0, G81.01, G81.02, G81.03, G81.04, G81.91, G81.92, G81.93, G81.94, G83.84, H53.131, H53.132, H53.133, H53.139, I63.231, I63.232, I69.320, I69.321, I69.322, I69.323, I69.351, I69.352, I69.353, I69.354, R41.4, R47.01, R47.02, R47.1, R47.81, R47.89, R47.9, H53.8, H53.9, R26.0, R26.2, R27.8, R27.9 and R29.810 were added when presented for comment.

03/16/2023 R1

Under CMS National Coverage Policy added the following regulations: CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §20 Payment Conditions for Radiology Services and CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §20.9 National Correct Coding Initiative (NCCI).

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
04/12/2024 06/02/2024 - N/A Future Effective You are here
03/10/2023 03/16/2023 - 06/01/2024 Currently in Effect View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Cerebral
  • CTP
  • Computed Tomography