About this policy
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Scalp Cooling for the Prevention of Chemotherapy-Induced Alopecia L39573 . Documentation Requirements All documentation must be maintained in the patient’s medical record and available to the contractor upon request. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. The medical record documentation must support the medical necessity of the services as directed in the related LCD.
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 |
|---|---|---|
| 97007 | HCPCS | Covered |
| 97008 | HCPCS | Covered |
| 97009 | HCPCS | Covered |
| C00.0 | ICD10CM | Covered |
| C00.1 | ICD10CM | Covered |
| C00.2 | ICD10CM | Covered |
| C00.3 | ICD10CM | Covered |
| C00.4 | ICD10CM | Covered |
| C00.5 | ICD10CM | Covered |
| C00.6 | ICD10CM | Covered |
| C00.8 | ICD10CM | Covered |
| C00.9 | ICD10CM | Covered |
| C01 | ICD10CM | Covered |
| C02.0 | ICD10CM | Covered |