Documentation requirements
Assuming services are being provided based on this indication, and the above requirements are documented, the claim should be coded with ICD-10-CM code B35.1 as a primary code AND L02.611- L02.612, L03.031-L03.032, L03.041-L03.042, M79.671- M79.672, M79.674-M79.675 or R26.2 as a secondary code. Systemic condition modifiers are not necessary for services performed for this indication with these diagnosis codes.
When the patient’s condition is 1 of those designated by an asterisk (*) above, routine procedures are covered only if the patient is under the active care of a doctor of medicine or osteopathy who documents the condition. This must be indicated by the name and national provider identifier (NPI) of the attending physician in block 17 and 17B of the CMS-1500 or the equivalent electronic claim format. The date the patient was last seen (DPLS) by the attending physician should be billed in block 19. Claims for such routine services should show the complicating systemic disease in block 21 of the CMS-1500.
For ICD-10-CM codes designated by an asterisk (*), we will require the DPLS and the NPI of the doctor of medicine or osteopathy.
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.
Showing the first 1,000 of 1,048 codes. The source has the full list.
| Code | Code system | Status in this policy |
|---|---|---|
| 11055 | HCPCS | Covered |
| 11056 | HCPCS | Covered |
| 11057 | HCPCS | Covered |
| 11719 | HCPCS | Covered |
| 11720 | HCPCS | Covered |
| 11721 | HCPCS | Covered |
| G0127 | HCPCS | Covered |
| A30.0 | ICD10CM | Covered |
| A30.1 | ICD10CM | Covered |
| A30.2 | ICD10CM | Covered |
| A30.3 | ICD10CM | Covered |
| A30.4 | ICD10CM | Covered |