About this policy
The following coding and billing guidance is to be used with its associated Local coverage determination.
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 |
|---|---|---|
| 11980 | HCPCS | Covered |
| 84410 | HCPCS | Covered |
| 96372 | HCPCS | Covered |
| J1071 | HCPCS | Covered |
| J3121 | HCPCS | Covered |
| J3145 | HCPCS | Covered |
| J3490 | HCPCS | Covered |
| D35.2 | ICD10CM | Covered |
| D44.3 | ICD10CM | Covered |
| E23.0 | ICD10CM | Covered |
| E23.1 | ICD10CM | Covered |
| E23.3 | ICD10CM | Covered |
| E23.6 | ICD10CM | Covered |
| E23.7 | ICD10CM | Covered |
| E29.1 | ICD10CM | Covered |
| E29.8 | ICD10CM | Covered |
| E89.5 | ICD10CM | Covered |
| N50.89 | ICD10CM | Covered |