CPT II Code. Exclusions. Comprehensive Diabetes Care. Whether or not patient age 18-75 years had screening or monitoring for diabetic retinal disease • 2022F - Dilated retinal eye exam with interpretation by ophthalmologist or optometrist documented and reviewed with evidence of retinopathy

Medical policies and clinical utilization management guidelines help us determine if a procedure is medically necessary. Visit Anthem.com to learn more about how these policies are used to determine patient coverage and medical necessity.

20985. C. 2.50. Dec 6, 2017 20985. Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to code. AMA recommends unlisted code for Subchondroplasty of the knee based on CT/MRI images; 20985-Computer-assisted surgical navigational procedure for Feb 17, 2014 Note: Submit the CPT/HCPCS code only once and without a modifier to for Musculoskeletal Procedures (CPT codes 20985, 0054T, and Oct 22, 2009 +20985 Computer assisted surgical navigational procedure for musculoskeletal procedures, image-less (list separately in addition to code for Apr 1, 2018 Code. Procedure Description. Effective Date.

Therefore, CPT code 20985 will be denied as not proven effective. Back to Top Coding Information Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Applicable codes: 20985, 0054T, 0055T. 0396T : Codes are intended to be used in addition to the code for the primary procedure. Surgical Navigation for Musculoskeletal Procedures (CPT ® codes 20985, 0054T, 0055T and 0396T) as it is considered incidental to the primary overall service. CMS 1500 . Developmental Screening (96110) Separate reimbursement is allowed for developmental screening (CPT ® code 96110) when submitted with problem-based (CPT ® 20985 : Computer-assisted surgical navigation procedure for musculoskeletal procedures, image-less: 77401 - 77412: Radiation treatment delivery [following total knee arthroplasty] Other CPT codes related to the CPB: 27440: Arthroplasty, knee, tibial plateau: 27441: with debridement and partial synovectomy: 27442 Surgical Navigation for Musculoskeletal Procedures (CPT® codes 20985, 0054T, and 0055T) as it is considered incidental to the primary overall service.

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proper code selection, often this will be an ostectomy code. Since arthroplasty is a resurfacing procedure of an arthritic joint, look at codes for excision bone cyst/benign tumor since CPT has stated that exostosis are considered benign bone tumors (CPT Assistant April 2012)

CMS 1500 20985 : Computer-assisted surgical navigation procedure for musculoskeletal procedures, image-less: 77401 - 77412: Radiation treatment delivery [following total knee arthroplasty] Other CPT codes related to the CPB: 27440: Arthroplasty, knee, tibial plateau: 27441: with debridement and partial synovectomy: 27442 No Government Pay Procedure Code List This list is used as an editing tool only. Please consult the authoritative guidance found in the TRICARE Policy Manual or TRICARE Reimbursement Manual to obtain specific information on TRICARE policy, benefits, and coverage.

Surgical Navigation for Musculoskeletal Procedures (CPT® codes 20985, 0054T, and 0055T) as it is considered incidental to the primary overall service. CMS 1500

For guidelines for Open Osteochondral Autograft, talus (CPT code 28446); Autologous Chondrocyte Transplantation in the Knee (CPT Code 27412); and Osteochondral Grafting of Knee (CPT Codes 29866, 29867, 27415 and 27416), refer to Coverage Summary for Orthopedic Procedures, Devices and Products. II. DEFINITIONS III. REFERENCES IV. REVISION HISTORY CPT code 99201 (new patient E/M) will be a deleted code. CPT codes 99202 through 99215 (new/established E/M) definitions have changed.

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Therefore, CPT code 20985 will be denied as not proven effective.
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Code is a unilateral code and requires a -50 Modifier if done bilaterally CPT 63047 –Laminectomy Code is a unilateral or bilateral code and reports either without modifier Why does this Matter? CPT CODE 2013 Medicare National Average Reimbursement for Physician - cms.gov, Physician Fee Schedule 63030 $980 63030-50 $1470 63047 $1119

The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.

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Applicable codes: 20985, 0054T, 0055T. 0396T : Codes are intended to be used in addition to the code for the primary procedure.

55.80. Ablate Bone Tumor(S) Perq. 20985. C. 2.50. Dec 6, 2017 20985.