About this policy
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Intraoperative Radiation Therapy L37779 . ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim. Claims submitted without such evidence will be denied as not medically necessary.
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 |
|---|---|---|
| 19294 | HCPCS | Covered |
| 76145 | HCPCS | Covered |
| 77424 | HCPCS | Covered |
| 77425 | HCPCS | Covered |
| 77469 | HCPCS | Covered |
| C9726 | HCPCS | Covered |
| C18.0 | ICD10CM | Covered |
| C18.1 | ICD10CM | Covered |
| C18.2 | ICD10CM | Covered |
| C18.3 | ICD10CM | Covered |
| C18.4 | ICD10CM | Covered |
| C18.5 | ICD10CM | Covered |
| C18.6 | ICD10CM | Covered |
| C18.7 | ICD10CM | Covered |
| C18.8 | ICD10CM | Covered |
| C18.9 | ICD10CM | Covered |
| C19 | ICD10CM | Covered |
| C20 | ICD10CM | Covered |
| C48.0 | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C49.11 | ICD10CM | Covered |
| C49.12 | ICD10CM | Covered |
| C49.21 | ICD10CM | Covered |
| C49.22 | ICD10CM | Covered |
| C49.3 | ICD10CM | Covered |
| C49.4 | ICD10CM | Covered |
| C49.5 | ICD10CM | Covered |
| C49.6 | ICD10CM | Covered |
| C49.8 | ICD10CM | Covered |
| C49.9 | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.012 | ICD10CM | Covered |
| C50.111 | ICD10CM | Covered |
| C50.112 | ICD10CM | Covered |
| C50.211 | ICD10CM | Covered |
| C50.212 | ICD10CM | Covered |
| C50.311 | ICD10CM | Covered |
| C50.312 | ICD10CM | Covered |
| C50.411 | ICD10CM | Covered |
| C50.412 | ICD10CM | Covered |
| C50.511 | ICD10CM | Covered |
| C50.512 | ICD10CM | Covered |
| C50.611 | ICD10CM | Covered |
| C50.612 | ICD10CM | Covered |
| C50.811 | ICD10CM | Covered |
| C50.812 | ICD10CM | Covered |
| C50.911 | ICD10CM | Covered |
| C50.912 | ICD10CM | Covered |
| C50.A1 | ICD10CM | Covered |
| C50.A2 | ICD10CM | Covered |
| C53.0 | ICD10CM | Covered |
| C53.1 | ICD10CM | Covered |
| C53.8 | ICD10CM | Covered |
| C53.9 | ICD10CM | Covered |
| C54.0 | ICD10CM | Covered |
| C54.1 | ICD10CM | Covered |
| C54.2 | ICD10CM | Covered |
| C54.3 | ICD10CM | Covered |
| C54.8 | ICD10CM | Covered |
| C54.9 | ICD10CM | Covered |
| C55 | ICD10CM | Covered |
| D05.11 | ICD10CM | Covered |
| D05.12 | ICD10CM | Covered |
| Z17.0 | ICD10CM | Covered |