Superseded Local Coverage Article Billing and Coding

Billing and Coding: Cervical Disc Replacement

A57021

Expand All | Collapse All
Superseded
To see the currently-in-effect version of this document, go to the section.

Contractor Information

Article Information

General Information

Article ID
A57021
Article Title
Billing and Coding: Cervical Disc Replacement
Article Type
Billing and Coding
Original Effective Date
10/28/2019
Revision Effective Date
01/01/2022
Revision Ending Date
12/31/2022
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 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 © 2022 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 lacking the necessary information to process that claim.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Cervical Disc Replacement L38033.

Coding Information

CPT/HCPCS Codes

Group 1

(4 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT/HCPCS codes in their CPT book.

Group 1 Codes
CodeDescription
22856 Tot disc arthrp ant 1ntrspc
22858 Tot disc arthrp ant 2nd lvl
22861 Revise cerv artific disc
0098T Rev artific disc addl

Group 2

Group 2 Paragraph

CPT codes that DO NOT support reasonable and necessary criteria

Group 2 Codes

N/A

Group 3

(53 Codes)
Group 3 Paragraph

Other CPT codes related to this LCD

Group 3 Codes
CodeDescription
97010 - 97039 Hot or cold packs therapy - Physical therapy treatment
97110 - 97546 Therapeutic exercises - Work hardening add-on
0095T Rmvl artific disc addl crvcl

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(20 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
G54.2 Cervical root disorders, not elsewhere classified
G54.9 Nerve root and plexus disorder, unspecified
M48.02 Spinal stenosis, cervical region
M50.01 Cervical disc disorder with myelopathy, high cervical region
M50.021 Cervical disc disorder at C4-C5 level with myelopathy
M50.022 Cervical disc disorder at C5-C6 level with myelopathy
M50.023 Cervical disc disorder at C6-C7 level with myelopathy
M50.11 Cervical disc disorder with radiculopathy, high cervical region
M50.121 Cervical disc disorder at C4-C5 level with radiculopathy
M50.122 Cervical disc disorder at C5-C6 level with radiculopathy
M50.123 Cervical disc disorder at C6-C7 level with radiculopathy
M50.21 Other cervical disc displacement, high cervical region
M50.221 Other cervical disc displacement at C4-C5 level
M50.222 Other cervical disc displacement at C5-C6 level
M50.223 Other cervical disc displacement at C6-C7 level
M50.31 Other cervical disc degeneration, high cervical region
M50.321 Other cervical disc degeneration at C4-C5 level
M50.322 Other cervical disc degeneration at C5-C6 level
M50.323 Other cervical disc degeneration at C6-C7 level
M53.1 Cervicobrachial syndrome

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

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
Z98.1 Arthrodesis status

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 R4

Under CPT/HCPCS Codes Group 1: Codes the description was revised for codes 22856 and 22858. This revision is due to the Annual CPT/HCPCS update and is effective on 1/1/22.

06/17/2021 R3

Under CMS National Coverage Policy added regulation Title XVIII of the Social Security Act, §1833(e).

01/01/2021 R2

Under CPT/HCPCS Codes Group 1: Codes the description was revised for code 22861. This revision is due to the Q1 2021 CPT/HCPCS code update and has a retroactive effective date of 1/1/21.

01/01/2020 R1

Under CPT/HCPCS Codes Group 2: Codes deleted CPT® code 0375T. Under CPT/HCPCS Codes Group 3: Codes added CPT® codes 97129 and 97130. CPT® code 97127 was deleted. This revision is due to the Annual CPT®/HCPCS Code Update and becomes effective on 1/1/20.

Associated Documents

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
03/14/2023 03/23/2023 - N/A Currently in Effect View
01/23/2023 01/01/2023 - 03/22/2023 Superseded View
01/03/2022 01/01/2022 - 12/31/2022 Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A