SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Somatosensory Testing

A57041

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Superseded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

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57041
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Somatosensory Testing
Article Type
Billing and Coding
Original Effective Date
09/26/2019
Revision Effective Date
03/23/2023
Revision Ending Date
09/30/2023
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

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the
following CMS sources:
Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not
reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the
functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary
information to process the claim.

Code of Federal Regulations:

42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific
medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15:

80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests

CMS Publication 100-03, Medicare National Coverage Determinations Manual,Chapter 1, Part 2:

160.23 Sensory Nerve Conduction Threshold Tests (sNCTs)

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 23:

10.1-10.1.7 ICD-9-CM Coding for Diagnostic Tests

Article Guidance

Article Text

 

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L35906-Somatosensory Testing.

 

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

 

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

 

Documentations Requirements
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Medical record documentation maintained by the performing physician must clearly indicate the medical necessity of the service being billed. There should be evidence in the medical record that the test results were noted and influenced or contributed to the patient’s course of treatment. In addition, documentation that the service was performed must be included in the patient’s medical record. This documentation should include a hard copy computer generated recording of the test results along with the physician’s interpretation. The physician’s SEP report should note which nerves were tested, latencies at various testing points, and an evaluation of whether the resulting values are normal or abnormal. This information is normally found in the office/progress notes, hospital records, and/or procedure notes.

If the provider of somatosensory testing is other than the ordering or referring physician or nonphysician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies.

Providers of interpretations, supervision and performance of the technical portions of the studies must be capable of demonstrating documented training and experience for post-payment audit.

Utilization Guidelines
It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
071x Clinic - Rural Health
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
0510 Clinic - General Classification
0517 Clinic - Family Practice Clinic
0519 Clinic - Other Clinic
0520 Freestanding Clinic - General Classification
0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC
0523 Freestanding Clinic - Family Practice Clinic
0529 Freestanding Clinic - Other Freestanding Clinic
096X Professional Fees - General Classification
N/A

CPT/HCPCS Codes

Group 1

(4 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
95925 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN UPPER LIMBS
95926 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN LOWER LIMBS
95927 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN THE TRUNK OR HEAD
95938 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN UPPER AND LOWER LIMBS
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(549 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
A18.01 Tuberculosis of spine
C41.2 Malignant neoplasm of vertebral column
C70.0 Malignant neoplasm of cerebral meninges
C70.1 Malignant neoplasm of spinal meninges
C72.0 Malignant neoplasm of spinal cord
C72.1 Malignant neoplasm of cauda equina
C72.21 Malignant neoplasm of right olfactory nerve
C72.22 Malignant neoplasm of left olfactory nerve
C72.31 Malignant neoplasm of right optic nerve
C72.32 Malignant neoplasm of left optic nerve
C72.41 Malignant neoplasm of right acoustic nerve
C72.42 Malignant neoplasm of left acoustic nerve
C72.50 Malignant neoplasm of unspecified cranial nerve
C72.59 Malignant neoplasm of other cranial nerves
C72.9 Malignant neoplasm of central nervous system, unspecified
C73 Malignant neoplasm of thyroid gland
C79.31 Secondary malignant neoplasm of brain
C79.32 Secondary malignant neoplasm of cerebral meninges
C79.40 Secondary malignant neoplasm of unspecified part of nervous system
C79.49 Secondary malignant neoplasm of other parts of nervous system
D21.0 Benign neoplasm of connective and other soft tissue of head, face and neck
D32.0 Benign neoplasm of cerebral meninges
D32.1 Benign neoplasm of spinal meninges
D32.9 Benign neoplasm of meninges, unspecified
D33.0 Benign neoplasm of brain, supratentorial
D33.1 Benign neoplasm of brain, infratentorial
D33.2 Benign neoplasm of brain, unspecified
D33.3 Benign neoplasm of cranial nerves
D33.4 Benign neoplasm of spinal cord
D33.7 Benign neoplasm of other specified parts of central nervous system
D33.9 Benign neoplasm of central nervous system, unspecified
D42.0 Neoplasm of uncertain behavior of cerebral meninges
D42.1 Neoplasm of uncertain behavior of spinal meninges
D43.0 Neoplasm of uncertain behavior of brain, supratentorial
D43.1 Neoplasm of uncertain behavior of brain, infratentorial
D43.2 Neoplasm of uncertain behavior of brain, unspecified
D43.3 Neoplasm of uncertain behavior of cranial nerves
D43.4 Neoplasm of uncertain behavior of spinal cord
D43.8 Neoplasm of uncertain behavior of other specified parts of central nervous system
D43.9 Neoplasm of uncertain behavior of central nervous system, unspecified
D44.3 Neoplasm of uncertain behavior of pituitary gland
D44.4 Neoplasm of uncertain behavior of craniopharyngeal duct
D44.5 Neoplasm of uncertain behavior of pineal gland
D44.6 Neoplasm of uncertain behavior of carotid body
D44.7 Neoplasm of uncertain behavior of aortic body and other paraganglia
D49.6 Neoplasm of unspecified behavior of brain
E03.5 Myxedema coma
G06.1 Intraspinal abscess and granuloma
G11.11 Friedreich ataxia
G11.19 Other early-onset cerebellar ataxia
G11.3 Cerebellar ataxia with defective DNA repair
G11.4 Hereditary spastic paraplegia
G11.8 Other hereditary ataxias
G25.3 Myoclonus
G35 Multiple sclerosis
G36.0 Neuromyelitis optica [Devic]
G37.0 Diffuse sclerosis of central nervous system
G37.3 Acute transverse myelitis in demyelinating disease of central nervous system
G37.5 Concentric sclerosis [Balo] of central nervous system
G40.011 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus
G40.019 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus
G40.111 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus
G40.119 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus
G40.211 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus
G40.219 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus
G45.0 Vertebro-basilar artery syndrome
G45.1 Carotid artery syndrome (hemispheric)
G45.2 Multiple and bilateral precerebral artery syndromes
G45.8 Other transient cerebral ischemic attacks and related syndromes
G46.0 Middle cerebral artery syndrome
G46.1 Anterior cerebral artery syndrome
G46.2 Posterior cerebral artery syndrome
G50.0 Trigeminal neuralgia
G50.1 Atypical facial pain
G52.9 Cranial nerve disorder, unspecified
G53 Cranial nerve disorders in diseases classified elsewhere
G54.0 Brachial plexus disorders
G54.1 Lumbosacral plexus disorders
G54.2 Cervical root disorders, not elsewhere classified
G54.3 Thoracic root disorders, not elsewhere classified
G54.4 Lumbosacral root disorders, not elsewhere classified
G80.4 Ataxic cerebral palsy
G80.8 Other cerebral palsy
G80.9 Cerebral palsy, unspecified
G93.5 Compression of brain
G95.0 Syringomyelia and syringobulbia
G95.20 Unspecified cord compression
G95.29 Other cord compression
G95.9 Disease of spinal cord, unspecified
H71.01 Cholesteatoma of attic, right ear
H71.02 Cholesteatoma of attic, left ear
H71.03 Cholesteatoma of attic, bilateral
H71.11 Cholesteatoma of tympanum, right ear
H71.12 Cholesteatoma of tympanum, left ear
H71.13 Cholesteatoma of tympanum, bilateral
H71.21 Cholesteatoma of mastoid, right ear
H71.22 Cholesteatoma of mastoid, left ear
H71.23 Cholesteatoma of mastoid, bilateral
H71.31 Diffuse cholesteatosis, right ear
H71.32 Diffuse cholesteatosis, left ear
H71.33 Diffuse cholesteatosis, bilateral
H71.91 Unspecified cholesteatoma, right ear
H71.92 Unspecified cholesteatoma, left ear
H71.93 Unspecified cholesteatoma, bilateral
H74.41 Polyp of right middle ear
H74.42 Polyp of left middle ear
H74.43 Polyp of middle ear, bilateral
H83.11 Labyrinthine fistula, right ear
H83.12 Labyrinthine fistula, left ear
H83.13 Labyrinthine fistula, bilateral
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.7 Nontraumatic subarachnoid hemorrhage from unspecified intracranial artery
I60.8 Other nontraumatic subarachnoid hemorrhage
I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical
I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical
I61.3 Nontraumatic intracerebral hemorrhage in brain stem
I61.4 Nontraumatic intracerebral hemorrhage in cerebellum
I61.5 Nontraumatic intracerebral hemorrhage, intraventricular
I61.6 Nontraumatic intracerebral hemorrhage, multiple localized
I61.8 Other nontraumatic intracerebral hemorrhage
I62.01 Nontraumatic acute subdural hemorrhage
I62.02 Nontraumatic subacute subdural hemorrhage
I62.03 Nontraumatic chronic subdural hemorrhage
I62.1 Nontraumatic extradural hemorrhage
I62.9 Nontraumatic intracranial hemorrhage, unspecified
I63.00 Cerebral infarction due to thrombosis of unspecified precerebral artery
I63.011 Cerebral infarction due to thrombosis of right vertebral artery
I63.012 Cerebral infarction due to thrombosis of left vertebral artery
I63.02 Cerebral infarction due to thrombosis of basilar artery
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.09 Cerebral infarction due to thrombosis of other precerebral artery
I63.10 Cerebral infarction due to embolism of unspecified precerebral artery
I63.111 Cerebral infarction due to embolism of right vertebral artery
I63.112 Cerebral infarction due to embolism of left vertebral artery
I63.12 Cerebral infarction due to embolism of basilar artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.19 Cerebral infarction due to embolism of other precerebral artery
I63.20 Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries
I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar 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
I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral 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
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.39 Cerebral infarction due to thrombosis of other 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
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.49 Cerebral infarction due to embolism of other 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
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I65.01 Occlusion and stenosis of right vertebral artery
I65.02 Occlusion and stenosis of left vertebral artery
I65.03 Occlusion and stenosis of bilateral vertebral arteries
I65.1 Occlusion and stenosis of basilar artery
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.8 Occlusion and stenosis of other precerebral arteries
I65.9 Occlusion and stenosis of unspecified precerebral artery
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I67.0 Dissection of cerebral arteries, nonruptured
I67.1 Cerebral aneurysm, nonruptured
I67.5 Moyamoya disease
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I67.850 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
I67.858 Other hereditary cerebrovascular disease
I71.00 Dissection of unspecified site of aorta
I71.010 Dissection of ascending aorta
I71.011 Dissection of aortic arch
I71.012 Dissection of descending thoracic aorta
I71.019 Dissection of thoracic aorta, unspecified
I71.02 Dissection of abdominal aorta
I71.03 Dissection of thoracoabdominal aorta
I71.11 Aneurysm of the ascending aorta, ruptured
I71.12 Aneurysm of the aortic arch, ruptured
I71.13 Aneurysm of the descending thoracic aorta, ruptured
I71.21 Aneurysm of the ascending aorta, without rupture
I71.22 Aneurysm of the aortic arch, without rupture
I71.23 Aneurysm of the descending thoracic aorta, without rupture
I71.31 Pararenal abdominal aortic aneurysm, ruptured
I71.32 Juxtarenal abdominal aortic aneurysm, ruptured
I71.33 Infrarenal abdominal aortic aneurysm, ruptured
I71.41 Pararenal abdominal aortic aneurysm, without rupture
I71.42 Juxtarenal abdominal aortic aneurysm, without rupture
I71.43 Infrarenal abdominal aortic aneurysm, without rupture
I71.51 Supraceliac aneurysm of the abdominal aorta, ruptured
I71.52 Paravisceral aneurysm of the abdominal aorta, ruptured
I71.61 Supraceliac aneurysm of the abdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the abdominal aorta, without rupture
I71.8 Aortic aneurysm of unspecified site, ruptured
I71.9 Aortic aneurysm of unspecified site, without rupture
I77.71 Dissection of carotid artery
I77.74 Dissection of vertebral artery
I77.79 Dissection of other specified artery
I79.0 Aneurysm of aorta in diseases classified elsewhere
M40.03 Postural kyphosis, cervicothoracic region
M40.04 Postural kyphosis, thoracic region
M40.05 Postural kyphosis, thoracolumbar region
M40.12 Other secondary kyphosis, cervical region
M40.13 Other secondary kyphosis, cervicothoracic region
M40.14 Other secondary kyphosis, thoracic region
M40.15 Other secondary kyphosis, thoracolumbar region
M40.202 Unspecified kyphosis, cervical region
M40.203 Unspecified kyphosis, cervicothoracic region
M40.204 Unspecified kyphosis, thoracic region
M40.205 Unspecified kyphosis, thoracolumbar region
M40.292 Other kyphosis, cervical region
M40.293 Other kyphosis, cervicothoracic region
M40.294 Other kyphosis, thoracic region
M40.295 Other kyphosis, thoracolumbar region
M40.35 Flatback syndrome, thoracolumbar region
M40.36 Flatback syndrome, lumbar region
M40.37 Flatback syndrome, lumbosacral region
M40.45 Postural lordosis, thoracolumbar region
M40.46 Postural lordosis, lumbar region
M40.47 Postural lordosis, lumbosacral region
M40.55 Lordosis, unspecified, thoracolumbar region
M40.56 Lordosis, unspecified, lumbar region
M40.57 Lordosis, unspecified, lumbosacral region
M41.02 Infantile idiopathic scoliosis, cervical region
M41.03 Infantile idiopathic scoliosis, cervicothoracic region
M41.04 Infantile idiopathic scoliosis, thoracic region
M41.05 Infantile idiopathic scoliosis, thoracolumbar region
M41.06 Infantile idiopathic scoliosis, lumbar region
M41.07 Infantile idiopathic scoliosis, lumbosacral region
M41.08 Infantile idiopathic scoliosis, sacral and sacrococcygeal region
M41.112 Juvenile idiopathic scoliosis, cervical region
M41.113 Juvenile idiopathic scoliosis, cervicothoracic region
M41.114 Juvenile idiopathic scoliosis, thoracic region
M41.115 Juvenile idiopathic scoliosis, thoracolumbar region
M41.116 Juvenile idiopathic scoliosis, lumbar region
M41.117 Juvenile idiopathic scoliosis, lumbosacral region
M41.122 Adolescent idiopathic scoliosis, cervical region
M41.123 Adolescent idiopathic scoliosis, cervicothoracic region
M41.124 Adolescent idiopathic scoliosis, thoracic region
M41.125 Adolescent idiopathic scoliosis, thoracolumbar region
M41.126 Adolescent idiopathic scoliosis, lumbar region
M41.127 Adolescent idiopathic scoliosis, lumbosacral region
M41.22 Other idiopathic scoliosis, cervical region
M41.23 Other idiopathic scoliosis, cervicothoracic region
M41.24 Other idiopathic scoliosis, thoracic region
M41.25 Other idiopathic scoliosis, thoracolumbar region
M41.26 Other idiopathic scoliosis, lumbar region
M41.27 Other idiopathic scoliosis, lumbosacral region
M41.41 Neuromuscular scoliosis, occipito-atlanto-axial region
M41.42 Neuromuscular scoliosis, cervical region
M41.43 Neuromuscular scoliosis, cervicothoracic region
M41.44 Neuromuscular scoliosis, thoracic region
M41.45 Neuromuscular scoliosis, thoracolumbar region
M41.46 Neuromuscular scoliosis, lumbar region
M41.47 Neuromuscular scoliosis, lumbosacral region
M41.52 Other secondary scoliosis, cervical region
M41.53 Other secondary scoliosis, cervicothoracic region
M41.54 Other secondary scoliosis, thoracic region
M41.55 Other secondary scoliosis, thoracolumbar region
M41.56 Other secondary scoliosis, lumbar region
M41.57 Other secondary scoliosis, lumbosacral region
M41.82 Other forms of scoliosis, cervical region
M41.83 Other forms of scoliosis, cervicothoracic region
M41.84 Other forms of scoliosis, thoracic region
M41.85 Other forms of scoliosis, thoracolumbar region
M41.86 Other forms of scoliosis, lumbar region
M41.87 Other forms of scoliosis, lumbosacral region
M43.8X1 Other specified deforming dorsopathies, occipito-atlanto-axial region
M43.8X2 Other specified deforming dorsopathies, cervical region
M43.8X3 Other specified deforming dorsopathies, cervicothoracic region
M43.8X4 Other specified deforming dorsopathies, thoracic region
M43.8X5 Other specified deforming dorsopathies, thoracolumbar region
M43.8X6 Other specified deforming dorsopathies, lumbar region
M43.8X7 Other specified deforming dorsopathies, lumbosacral region
M43.8X8 Other specified deforming dorsopathies, sacral and sacrococcygeal region
M43.8X9 Other specified deforming dorsopathies, site unspecified
M43.9 Deforming dorsopathy, unspecified
M47.011 Anterior spinal artery compression syndromes, occipito-atlanto-axial region
M47.012 Anterior spinal artery compression syndromes, cervical region
M47.013 Anterior spinal artery compression syndromes, cervicothoracic region
M47.014 Anterior spinal artery compression syndromes, thoracic region
M47.015 Anterior spinal artery compression syndromes, thoracolumbar region
M47.016 Anterior spinal artery compression syndromes, lumbar region
M47.021 Vertebral artery compression syndromes, occipito-atlanto-axial region
M47.022 Vertebral artery compression syndromes, cervical region
M47.10 Other spondylosis with myelopathy, site unspecified
M47.11 Other spondylosis with myelopathy, occipito-atlanto-axial region
M47.12 Other spondylosis with myelopathy, cervical region
M47.13 Other spondylosis with myelopathy, cervicothoracic region
M47.14 Other spondylosis with myelopathy, thoracic region
M47.15 Other spondylosis with myelopathy, thoracolumbar region
M47.16 Other spondylosis with myelopathy, lumbar region
M47.24 Other spondylosis with radiculopathy, thoracic region
M47.25 Other spondylosis with radiculopathy, thoracolumbar region
M47.26 Other spondylosis with radiculopathy, lumbar region
M47.27 Other spondylosis with radiculopathy, lumbosacral region
M47.28 Other spondylosis with radiculopathy, sacral and sacrococcygeal region
M47.814 Spondylosis without myelopathy or radiculopathy, thoracic region
M47.815 Spondylosis without myelopathy or radiculopathy, thoracolumbar region
M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region
M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.818 Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region
M47.894 Other spondylosis, thoracic region
M47.895 Other spondylosis, thoracolumbar region
M47.896 Other spondylosis, lumbar region
M47.897 Other spondylosis, lumbosacral region
M47.898 Other spondylosis, sacral and sacrococcygeal region
M48.01 Spinal stenosis, occipito-atlanto-axial region
M48.02 Spinal stenosis, cervical region
M48.03 Spinal stenosis, cervicothoracic region
M48.04 Spinal stenosis, thoracic region
M48.05 Spinal stenosis, thoracolumbar region
M48.061 Spinal stenosis, lumbar region without neurogenic claudication
M48.062 Spinal stenosis, lumbar region with neurogenic claudication
M48.07 Spinal stenosis, lumbosacral 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
M50.03 Cervical disc disorder with myelopathy, cervicothoracic region
M51.04 Intervertebral disc disorders with myelopathy, thoracic region
M51.05 Intervertebral disc disorders with myelopathy, thoracolumbar region
M51.06 Intervertebral disc disorders with myelopathy, lumbar region
M51.9 Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder
M96.2 Postradiation kyphosis
M96.3 Postlaminectomy kyphosis
M96.4 Postsurgical lordosis
M96.5 Postradiation scoliosis
M99.20 Subluxation stenosis of neural canal of head region
M99.21 Subluxation stenosis of neural canal of cervical region
M99.22 Subluxation stenosis of neural canal of thoracic region
M99.23 Subluxation stenosis of neural canal of lumbar region
M99.30 Osseous stenosis of neural canal of head region
M99.31 Osseous stenosis of neural canal of cervical region
M99.32 Osseous stenosis of neural canal of thoracic region
M99.33 Osseous stenosis of neural canal of lumbar region
M99.40 Connective tissue stenosis of neural canal of head region
M99.41 Connective tissue stenosis of neural canal of cervical region
M99.42 Connective tissue stenosis of neural canal of thoracic region
M99.43 Connective tissue stenosis of neural canal of lumbar region
M99.50 Intervertebral disc stenosis of neural canal of head region
M99.51 Intervertebral disc stenosis of neural canal of cervical region
M99.52 Intervertebral disc stenosis of neural canal of thoracic region
M99.53 Intervertebral disc stenosis of neural canal of lumbar region
M99.60 Osseous and subluxation stenosis of intervertebral foramina of head region
M99.61 Osseous and subluxation stenosis of intervertebral foramina of cervical region
M99.62 Osseous and subluxation stenosis of intervertebral foramina of thoracic region
M99.63 Osseous and subluxation stenosis of intervertebral foramina of lumbar region
M99.70 Connective tissue and disc stenosis of intervertebral foramina of head region
M99.71 Connective tissue and disc stenosis of intervertebral foramina of cervical region
M99.72 Connective tissue and disc stenosis of intervertebral foramina of thoracic region
M99.73 Connective tissue and disc stenosis of intervertebral foramina of lumbar region
P11.3 Birth injury to facial nerve
P11.4 Birth injury to other cranial nerves
P11.5 Birth injury to spine and spinal cord
P14.0 Erb's paralysis due to birth injury
P14.1 Klumpke's paralysis due to birth injury
P14.2 Phrenic nerve paralysis due to birth injury
P14.3 Other brachial plexus birth injuries
P14.8 Birth injuries to other parts of peripheral nervous system
Q05.0 Cervical spina bifida with hydrocephalus
Q05.1 Thoracic spina bifida with hydrocephalus
Q05.2 Lumbar spina bifida with hydrocephalus
Q05.3 Sacral spina bifida with hydrocephalus
Q05.4 Unspecified spina bifida with hydrocephalus
Q05.5 Cervical spina bifida without hydrocephalus
Q05.6 Thoracic spina bifida without hydrocephalus
Q05.7 Lumbar spina bifida without hydrocephalus
Q05.8 Sacral spina bifida without hydrocephalus
Q07.00 Arnold-Chiari syndrome without spina bifida or hydrocephalus
Q07.01 Arnold-Chiari syndrome with spina bifida
Q07.02 Arnold-Chiari syndrome with hydrocephalus
Q07.03 Arnold-Chiari syndrome with spina bifida and hydrocephalus
Q27.9 Congenital malformation of peripheral vascular system, unspecified
Q28.2 Arteriovenous malformation of cerebral vessels
Q28.3 Other malformations of cerebral vessels
Q85.00 Neurofibromatosis, unspecified
Q85.01 Neurofibromatosis, type 1
Q85.02 Neurofibromatosis, type 2
Q85.03 Schwannomatosis
Q85.09 Other neurofibromatosis
R20.0* Anesthesia of skin
R20.1* Hypoesthesia of skin
R20.2* Paresthesia of skin
R20.3* Hyperesthesia
R20.8* Other disturbances of skin sensation
R40.2110 Coma scale, eyes open, never, unspecified time
R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance]
R40.2112 Coma scale, eyes open, never, at arrival to emergency department
R40.2113 Coma scale, eyes open, never, at hospital admission
R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2120 Coma scale, eyes open, to pain, unspecified time
R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance]
R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department
R40.2123 Coma scale, eyes open, to pain, at hospital admission
R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2210 Coma scale, best verbal response, none, unspecified time
R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance]
R40.2212 Coma scale, best verbal response, none, at arrival to emergency department
R40.2213 Coma scale, best verbal response, none, at hospital admission
R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time
R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2310 Coma scale, best motor response, none, unspecified time
R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance]
R40.2312 Coma scale, best motor response, none, at arrival to emergency department
R40.2313 Coma scale, best motor response, none, at hospital admission
R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2320 Coma scale, best motor response, extension, unspecified time
R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance]
R40.2322 Coma scale, best motor response, extension, at arrival to emergency department
R40.2323 Coma scale, best motor response, extension, at hospital admission
R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time
R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission
R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
S14.2XXA Injury of nerve root of cervical spine, initial encounter
S14.3XXA Injury of brachial plexus, initial encounter
S24.2XXA Injury of nerve root of thoracic spine, initial encounter
S34.21XA Injury of nerve root of lumbar spine, initial encounter
S34.22XA Injury of nerve root of sacral spine, initial encounter
S34.4XXA Injury of lumbosacral plexus, initial encounter
S44.01XA Injury of ulnar nerve at upper arm level, right arm, initial encounter
S44.02XA Injury of ulnar nerve at upper arm level, left arm, initial encounter
S44.11XA Injury of median nerve at upper arm level, right arm, initial encounter
S44.12XA Injury of median nerve at upper arm level, left arm, initial encounter
S44.21XA Injury of radial nerve at upper arm level, right arm, initial encounter
S44.22XA Injury of radial nerve at upper arm level, left arm, initial encounter
S44.30XA Injury of axillary nerve, unspecified arm, initial encounter
S44.31XA Injury of axillary nerve, right arm, initial encounter
S44.32XA Injury of axillary nerve, left arm, initial encounter
S44.41XA Injury of musculocutaneous nerve, right arm, initial encounter
S44.42XA Injury of musculocutaneous nerve, left arm, initial encounter
S44.51XA Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, initial encounter
S44.8X1A Injury of other nerves at shoulder and upper arm level, right arm, initial encounter
S44.8X2A Injury of other nerves at shoulder and upper arm level, left arm, initial encounter
S44.91XA Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter
S44.92XA Injury of unspecified nerve at shoulder and upper arm level, left arm, initial encounter
S54.01XA Injury of ulnar nerve at forearm level, right arm, initial encounter
S54.02XA Injury of ulnar nerve at forearm level, left arm, initial encounter
S54.11XA Injury of median nerve at forearm level, right arm, initial encounter
S54.12XA Injury of median nerve at forearm level, left arm, initial encounter
S54.21XA Injury of radial nerve at forearm level, right arm, initial encounter
S54.22XA Injury of radial nerve at forearm level, left arm, initial encounter
S54.31XA Injury of cutaneous sensory nerve at forearm level, right arm, initial encounter
S54.32XA Injury of cutaneous sensory nerve at forearm level, left arm, initial encounter
S54.8X1A Injury of other nerves at forearm level, right arm, initial encounter
S54.8X2A Injury of other nerves at forearm level, left arm, initial encounter
S54.91XA Injury of unspecified nerve at forearm level, right arm, initial encounter
S54.92XA Injury of unspecified nerve at forearm level, left arm, initial encounter
S64.01XA Injury of ulnar nerve at wrist and hand level of right arm, initial encounter
S64.02XA Injury of ulnar nerve at wrist and hand level of left arm, initial encounter
S64.11XA Injury of median nerve at wrist and hand level of right arm, initial encounter
S64.12XA Injury of median nerve at wrist and hand level of left arm, initial encounter
S64.21XA Injury of radial nerve at wrist and hand level of right arm, initial encounter
S64.22XA Injury of radial nerve at wrist and hand level of left arm, initial encounter
S64.31XA Injury of digital nerve of right thumb, initial encounter
S64.32XA Injury of digital nerve of left thumb, initial encounter
S64.490A Injury of digital nerve of right index finger, initial encounter
S64.491A Injury of digital nerve of left index finger, initial encounter
S64.492A Injury of digital nerve of right middle finger, initial encounter
S64.493A Injury of digital nerve of left middle finger, initial encounter
S64.494A Injury of digital nerve of right ring finger, initial encounter
S64.495A Injury of digital nerve of left ring finger, initial encounter
S64.496A Injury of digital nerve of right little finger, initial encounter
S64.497A Injury of digital nerve of left little finger, initial encounter
S64.8X1A Injury of other nerves at wrist and hand level of right arm, initial encounter
S64.8X2A Injury of other nerves at wrist and hand level of left arm, initial encounter
S64.91XA Injury of unspecified nerve at wrist and hand level of right arm, initial encounter
S64.92XA Injury of unspecified nerve at wrist and hand level of left arm, initial encounter
S74.01XA Injury of sciatic nerve at hip and thigh level, right leg, initial encounter
S74.02XA Injury of sciatic nerve at hip and thigh level, left leg, initial encounter
S74.11XA Injury of femoral nerve at hip and thigh level, right leg, initial encounter
S74.12XA Injury of femoral nerve at hip and thigh level, left leg, initial encounter
S74.21XA Injury of cutaneous sensory nerve at hip and high level, right leg, initial encounter
S74.22XA Injury of cutaneous sensory nerve at hip and thigh level, left leg, initial encounter
S74.8X1A Injury of other nerves at hip and thigh level, right leg, initial encounter
S74.8X2A Injury of other nerves at hip and thigh level, left leg, initial encounter
S74.91XA Injury of unspecified nerve at hip and thigh level, right leg, initial encounter
S74.92XA Injury of unspecified nerve at hip and thigh level, left leg, initial encounter
S84.01XA Injury of tibial nerve at lower leg level, right leg, initial encounter
S84.02XA Injury of tibial nerve at lower leg level, left leg, initial encounter
S84.11XA Injury of peroneal nerve at lower leg level, right leg, initial encounter
S84.12XA Injury of peroneal nerve at lower leg level, left leg, initial encounter
S84.21XA Injury of cutaneous sensory nerve at lower leg level, right leg, initial encounter
S84.22XA Injury of cutaneous sensory nerve at lower leg level, left leg, initial encounter
S84.801A Injury of other nerves at lower leg level, right leg, initial encounter
S84.802A Injury of other nerves at lower leg level, left leg, initial encounter
S84.91XA Injury of unspecified nerve at lower leg level, right leg, initial encounter
S94.01XA Injury of lateral plantar nerve, right leg, initial encounter
S94.02XA Injury of lateral plantar nerve, left leg, initial encounter
S94.11XA Injury of medial plantar nerve, right leg, initial encounter
S94.12XA Injury of medial plantar nerve, left leg, initial encounter
S94.21XA Injury of deep peroneal nerve at ankle and foot level, right leg, initial encounter
S94.22XA Injury of deep peroneal nerve at ankle and foot level, left leg, initial encounter
S94.31XA Injury of cutaneous sensory nerve at ankle and foot level, right leg, initial encounter
S94.32XA Injury of cutaneous sensory nerve at ankle and foot level, left leg, initial encounter
S94.8X1A Injury of other nerves at ankle and foot level, right leg, initial encounter
S94.8X2A Injury of other nerves at ankle and foot level, left leg, initial encounter
S94.91XA Injury of unspecified nerve at ankle and foot level, right leg, initial encounter
S94.92XA Injury of unspecified nerve at ankle and foot level, left leg, initial encounter
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

* Use ICD-10-CM codes R20.0, R20.1, R20.2, R20.3, or R20.8 for patients with suspected central nervous system disease causing disturbance of sensation for which a more definitive diagnosis has not been established.

N/A

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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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.

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
071x Clinic - Rural Health
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
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
0510 Clinic - General Classification
0517 Clinic - Family Practice Clinic
0519 Clinic - Other Clinic
0520 Freestanding Clinic - General Classification
0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC
0523 Freestanding Clinic - Family Practice Clinic
0529 Freestanding Clinic - Other Freestanding Clinic
096X Professional Fees - General Classification
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

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

Revision History Information

Revision History Date Revision History Number Revision History Explanation
03/23/2023 R8

R8

Revision Effective: 03/23/2023
Revision Explanation: Annual review, no changes 

11/10/2022 R7

R7

Revision Effective: 1/10/2022
Revision Explanation: CPT code 95928 was listed in the group CPT/HCPCS code section in error. This was a typo, and the code should have been 95938. This has been corrected and is retroactive to 09/26/2019.

10/01/2022 R6

R6

Revision Effective: 10/01/2022
Revision Explanation: Removed: I71.1, I71.2, I71.3, I71.4, I71.5 and I71.6 and added I71.11, I71.12, I71.13, I71.21, I71.22, I71.23, I71.31, I71.32, I71.33, I71.41, I71.42, I71.43, I71.51, I71.52, I71.61, and I71.62

10/01/2022 R5

 

R5
Revision Effective: 10/01/2022
Revision Explanation: Removed I71.01. Annual ICD-10 Update, added I71.010, I71.011, I71.012, and I71.019

03/31/2022 R4

R4
Revision Effective: 03/31/2022
Revision Explanation: Annual review, no changes made.

04/01/2021 R3

R3
Revision Effective: 04/01/2021
Revision Explanation: Annual review, no changes made.

10/01/2020 R2

R2
Revision Effective: 10/01/2020
Revision Explanation: During annual ICd-10 review G11.1 was deleted and replaced with G11.11 and G11.19.

03/25/2020 R1

Revision Effective: N/A

Revision Explanation: Annual Review, no changes.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
Articles
A54139 - (MCD Archive Site)
LCDs
L35906 - Somatosensory Testing
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
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
03/29/2024 04/04/2024 - N/A Currently in Effect View
11/07/2023 11/16/2023 - 04/03/2024 Superseded View
10/17/2023 10/01/2023 - 11/15/2023 Superseded View
03/13/2023 03/23/2023 - 09/30/2023 Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A