Documentation requirements
kx_modifier_mandate
kx_modifier_attestation_and_record
kx_drug_therapy_note
sc_modifier_use
ga_gz_modifier_and_abn
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 33206 | HCPCS | Covered |
| 33207 | HCPCS | Covered |
| 33208 | HCPCS | Covered |
| G90.01 | ICD10CM | Covered |
| I44.0 | ICD10CM | Covered |
| I44.1 | ICD10CM | Covered |
| I44.2 | ICD10CM | Covered |
| I44.30 | ICD10CM | Covered |
| I44.7 | ICD10CM | Covered |
| I45.10 | ICD10CM | Covered |
| I45.19 | ICD10CM | Covered |
| I45.2 | ICD10CM | Covered |
| I45.3 | ICD10CM | Covered |
| I47.10 | ICD10CM | Covered |
| I47.19 | ICD10CM | Covered |
| I47.9 | ICD10CM | Covered |
| I48.11 | ICD10CM | Covered |
| I48.19 | ICD10CM | Covered |
| I48.3 | ICD10CM | Covered |
| I48.4 | ICD10CM | Covered |
| I48.91 | ICD10CM | Covered |
| I48.92 | ICD10CM | Covered |
| I49.5 | ICD10CM | Covered |
| Q24.6 | ICD10CM | Covered |