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Medicare Correct Coding Guide A guide to Medicare billing and coding edits for physicians

Medicare C

orrect C

oding Guide

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January 2017 Contents–1© 2017 Optum360, LLCCPT © 2016 American Medical Association. All Rights Reserved.

Contents

Getting Started with Medicare Correct Coding Guide ......... Introduction–1

Introduction ........................................................................ Introduction–3Resource-Based Relative Value Scale ....................................... Introduction–3Sequestration Budget Reduction .............................................. Introduction–3Correct Coding Initiative .............................................................. Introduction–4

Medically Unlikely Edits .......................................................... Introduction–4National Correct Coding Initiative (NCCI)

Add-On Codes ................................................................... Introduction–5Manual Organization ..................................................................... Introduction–5How to Use This Book .................................................................... Introduction–5

Resource-Based Relative Value Scale (RBRVS) Payment Computation ................................................... Introduction–5

Modifiers ............................................................................................ Introduction–6Surgery Modifiers ..................................................................... Introduction–6Modifiers Affecting Correct Coding Edits ......................... Introduction–7

Other Payment Indicators ............................................................ Introduction–7Status Indicator ......................................................................... Introduction–7Global Period .............................................................................. Introduction–8Physician Supervision Level .................................................. Introduction–8Definitions ................................................................................... Introduction–8Levels of Physician Supervision of Diagnostic Tests ..... Introduction–8

Correct Coding Initiative (CCI) .................................................... Introduction–8Step-by-Step Instructions ............................................................ Introduction–9

Symbol/Payment Indicator Key ........................................ Introduction–11

Summary of Changes ............................................ Summary of Changes–1

General Correct Coding Policies.................................................. General–1A. Introduction ................................................................................ General–1B. Coding Based on Standards of Medical/

Surgical Practice ......................................................................... General–2C. Medical/Surgical Package ...................................................... General–2D. Evaluation and Management (E&M) Services ................. General–4E. Modifiers and Modifier Indicators ....................................... General–4F. Standard Preparation/Monitoring Services for

Anesthesia ................................................................................... General–6G. Anesthesia Service Included in the Surgical

Procedure .................................................................................... General–6H. HCPCS/CPT Procedure Code Definition ............................. General–7I. CPT Manual and CMS Coding Manual Instructions ........ General–7J. CPT “Separate Procedure” Definition ................................. General–7K. Family of Codes .......................................................................... General–7L. More Extensive Procedure ..................................................... General–7M. Sequential Procedure .............................................................. General–8N. Laboratory Panel ....................................................................... General–8O. Misuse of Column Two Code with Column One Code

(Misuse of Code Edit Rationale) ............................................ General–8P. Mutually Exclusive Procedures ............................................. General–8Q. Gender-Specific Procedures .................................................. General–8R. Add-on Codes ............................................................................. General–8S. Excluded Service ........................................................................ General–9T. Unlisted Procedure Codes ...................................................... General–9U. Modified, Deleted, and Added Code Pairs/Edits ............ General–9V. Medically Unlikely Edits (MUEs) ........................................... General–9W. Add-on Code Edit Tables ...................................................... General–11

Surgery: Integumentary System (CPT® Codes 10000–19999) ............................................ Integumentary–i

Correct Coding Policies .............................................................. Integumentary–iA. Introduction .................................................................... Integumentary–iB. Evaluation and Management (E&M) Services ..... Integumentary–i

C. Anesthesia ....................................................................... Integumentary–iD. Incision and Drainage ................................................. Integumentary–iiE. Lesion Removal ............................................................. Integumentary–iiF. Mohs Micrographic Surgery ..................................... Integumentary–iiG. Intralesional Injections ............................................... Integumentary–iiH. Repair and Tissue Transfer ....................................... Integumentary–iiiI. Grafts and Flaps ........................................................... Integumentary–iiiJ. Breast (Incision, Excision, Introduction,

Repair and Reconstruction) ..................................... Integumentary–iiiK. Medically Unlikely Edits (MUEs) ............................. Integumentary–iiiL. General Policy Statements ....................................... Integumentary–iii

Integumentary System ............................................................. Integumentary–1

Surgery: Musculoskeletal System (CPT® Codes 20005–29999) ...........................................Musculoskeletal–i

Correct Coding Policies ............................................................ Musculoskeletal–iA. Introduction .................................................................. Musculoskeletal–iB. Evaluation and Management (E&M) Services ... Musculoskeletal–iC. Anesthesia ..................................................................... Musculoskeletal–iD. Biopsy .............................................................................. Musculoskeletal–iE. Arthroscopy ................................................................. Musculoskeletal–iiF. Spine (Vertebral Column) ...................................... Musculoskeletal–iiG. Fractures, Dislocations, and Casting/

Splinting/Strapping ................................................. Musculoskeletal–iiiH. Medically Unlikely Edits (MUEs) ........................... Musculoskeletal–ivI. General Policy Statements ..................................... Musculoskeletal–iii

Musculoskeletal System ......................................................... Musculoskeletal–1

Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic Systems (CPT® Codes 30000–39599) ................................................. Respiratory–i

Correct Coding Policies ..................................................................... Respiratory–iA. Introduction ........................................................................... Respiratory–iB. Evaluation and Management (E&M) Services ............ Respiratory–iC. Respiratory System .............................................................. Respiratory–iD. Cardiovascular System ..................................................... Respiratory–iiiE. Hemic and Lymphatic Systems ..................................... Respiratory–viF. Mediastinum ........................................................................ Respiratory–viG. Medically Unlikely Edits (MUEs) .................................... Respiratory–viH. General Policy Statements ............................................. Respiratory–vii

Respiratory System ........................................................................... Respiratory–1Cardiovascular System ...................................................................Respiratory–74Hemic and Lymphatic System ................................................. Respiratory–234Mediastinum and Diaphragm ................................................... Respiratory–246

Surgery: Digestive System (CPT® Codes 40000–49999) ..........Digestive–iCorrect Coding Policies ......................................................................... Digestive–i

A. Introduction ............................................................................... Digestive–iB. Evaluation and Management (E&M) Services ................ Digestive–iC. Endoscopic Services ................................................................ Digestive–iD. Esophageal Procedures ........................................................ Digestive–iiE. Abdominal Procedures ......................................................... Digestive–iiF. Laparoscopy .............................................................................Digestive–iiiG. Medically Unlikely Edits (MUEs) ........................................Digestive–iiiH. General Policy Statements ..................................................Digestive–iii

Digestive System ...................................................................................Digestive–1

Surgery: Urinary, Male Genital, Female Genital, MaternityCare and Delivery Systems (CPT® Codes 50000–59999) ............. Urinary–i

Correct Coding Policies .............................................................................Urinary–iA. Introduction ...................................................................................Urinary–iB. Evaluation and Management (E&M) Services ....................Urinary–iC. Urinary System ..............................................................................Urinary–iD. Male Genital System .................................................................Urinary–iiiE. Female Genital System ............................................................Urinary–iii

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January 2017 General–1© 2017 Optum360, LLCCPT © 2016 American Medical Association. All Rights Reserved.

General Correct Coding Policies

A. IntroductionHealthcare providers utilize HCPCS/CPT® codes to report medical services performed on patients to Medicare Carriers (A/B MACs processing practitioner service claims) and Fiscal Intermediaries (FIs). HCPCS (Healthcare Common Procedure Coding System) consists of Level I CPT (Current Procedural Terminology) codes and Level II codes. CPT codes are defined in the American Medical Association’s (AMA’s) CPT Manual which is updated and published annually. HCPCS Level II codes are defined by the Centers for Medicare and Medicaid Services (CMS) and are updated throughout the year as necessary. Changes in CPT codes are approved by the AMA CPT Editorial Panel which meets three times per year.

Editor’s note: CPT Category II and Category III codes are updated twice yearly—in January and July—and can be found on the AMA website prior to their inclusion in the printed book.

CPT and HCPCS Level II codes define medical and surgical procedures performed on patients. Some procedure codes are very specific defining a single service (e.g., CPT code 93000 (electrocardiogram)) while other codes define procedures consisting of many services (e.g., CPT code 58263 (vaginal hysterectomy with removal of tube(s) and ovary(s) and repair of enterocele)). Because many procedures can be performed by different approaches, different methods, or in combination with other procedures, there are often multiple HCPCS/CPT codes defining similar or related procedures.

CPT and HCPCS Level II code descriptors usually do not define all services included in a procedure. There are often services inherent in a procedure or group of procedures. For example, anesthesia services include certain preparation and monitoring services.

The CMS developed the NCCI to prevent inappropriate payment of services that should not be reported together. Three types of edits are included in the NCCI—NCCI Procedure-to-Procedure (PTP) edits, Medically Unlikely Edits (MUE), and Add-on Code Edits.

Each edit table contains edits which are pairs of HCPCS/CPT codes that in general should not be reported together. Each edit has a column one and column two HCPCS/CPT code. If a provider reports the two codes of an edit pair, the column two code is denied, and the column one code is eligible for payment. However, if it is clinically appropriate to utilize an NCCI-associated modifier, both the column one and column two codes are eligible for payment. (NCCI-associated modifiers and their appropriate use are discussed elsewhere in this chapter.)

Medically Unlikely Edits (MUEs) prevent payment for an inappropriate number/quantity of the same service on a single day. An MUE for a HCPCS/CPT code is the maximum number of units of service (UOS) under most circumstances reportable by the same provider for the same beneficiary on the same date of service. The ideal MUE value for a HCPCS/CPT code is one that allows the vast majority of appropriately coded claims to pass the MUE. More information concerning MUEs is discussed in Section V of this chapter.

Add-on code edits are comprised of a list of HCPCS and CPT add-on codes and their associated primary codes. Payment is provided for an add-on code only when one of its primary codes is also eligible for payment.

In this Manual many policies are described utilizing the term “physician.” Unless indicated differently the usage of this term does not restrict the policies to physicians only but applies to all practitioners, hospitals, providers, or suppliers eligible to bill the relevant HCPCS/CPT codes pursuant to applicable portions of the Social Security Act (SSA) of 1965, the Code of Federal Regulations (CFR), and Medicare rules. In some sections of this Manual, the term “physician” would not include some of these entities because specific rules do not apply to them. For example, Anesthesia Rules (e.g., CMS Internet-Only Manual, Publication 100-04 [Medicare Claims Processing Manual], Chapter 12 [Physician/Nonphysician Practitioners], Section 50 [Payment for Anesthesiology Services]) and Global Surgery Rules (e.g., CMS Internet-Only Manual, Publication 100-04 [Medicare Claims Processing Manual], Chapter 12 [Physician/Nonphysician Practitioners], Section 40 [Surgeons and Global Surgery]) do not apply to hospitals.

Providers reporting services under Medicare’s hospital outpatient prospective payment system (OPPS) should report all services in accordance with appropriate Medicare Internet Only Manual (IOM) instructions.

Physicians must report services correctly. This manual discusses general coding principles in Chapter I and principles more relevant to other specific groups of HCPCS/CPT codes in the other chapters. There are certain types of improper coding that physicians must avoid.

Procedures should be reported with the most comprehensive CPT code that describes the services performed. Physicians must not unbundle the services described by a HCPCS/CPT code. Some examples follow:

A physician should not report multiple HCPCS/CPT codes when a single comprehensive HCPCS/CPT code describes these services. For example if a physician performs a vaginal hysterectomy on a uterus weighing less than 250 grams with bilateral salpingo-oophorectomy, the physician should report CPT code 58262 (Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)). The physician should not re-port CPT code 58260 (Vaginal hysterectomy, for uterus 250 g or less;) plus CPT code 58720 (Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)).

A physician should not fragment a procedure into component parts. For example, if a physician performs an anal endoscopy with biopsy, the phy-sician should report CPT code 46606 (Anoscopy; with biopsy, single or multiple). It is improper to unbundle this procedure and report CPT code 46600 (Anoscopy; diagnostic,...) plus CPT code 45100 (Biopsy of anorectal wall, anal approach...). The latter code is not intended to be utilized with an endoscopic procedure code.

A physician should not unbundle a bilateral procedure code into two uni-lateral procedure codes. For example if a physician performs bilateral mammography, the physician should report CPT code 77066 (Diagnostic mammography... bilateral). The physician should not report CPT code 77065 (Diagnostic mammography... unilateral) with two units of service, or 77065LT plus 77065RT.

A physician should not unbundle services that are integral to a more com-prehensive procedure. For example, surgical access is integral to a surgical procedure. A physician should not report CPT code 49000 (Exploratory laparotomy,...) when performing an open abdominal procedure such as a total abdominal colectomy (e.g., CPT code 44150).

Physicians must avoid downcoding. If a HCPCS/CPT code exists that describes the services performed, the physician must report this code rather than report a less comprehensive code with other codes describing the services not included in the less comprehensive code. For example if a physician performs a unilateral partial mastectomy with axillary lymphadenectomy, the provider should report CPT code 19302 (Mastectomy, partial...; with axillary lymphadenectomy). A physician should not report CPT code 19301 (Mastectomy, partial...) plus CPT code 38745 (Axillary lymphadenectomy; complete).

Physicians must avoid upcoding. A HCPCS/CPT code may be reported only if all services described by that code have been performed. For example, if a physician performs a superficial axillary lymphadenectomy (CPT code 38740), the physician should not report CPT code 38745 (Axillary lymphadenectomy; complete).

Physicians must report units of service correctly. Each HCPCS/CPT code has a defined unit of service for reporting purposes. A physician should not report units of service for a HCPCS/CPT code using a criterion that differs from the code’s defined unit of service. For example, some therapy codes are reported in fifteen minute increments (e.g., CPT codes 97110-97124). Others are reported per session (e.g., CPT codes 92507, 92508). A physician should not report a “per session” code using fifteen minute increments. CPT code 92507 or 92508 should be reported with one unit of service on a single date of service.

MUE and NCCI PTP edits are based on services provided by the same physician to the same beneficiary on the same date of service. Physicians should not inconvenience beneficiaries nor increase risks to beneficiaries by performing services on different dates of service to avoid MUE or NCCI PTP edits.

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Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder,hip, knee, subacromial bursa); without ultrasound guidance20610

OTHERRELATIVE VALUE UNITSMUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork4(3)01.331.720.420.810.120.79

INDICATORSMODIFIERSStatusSuprv80,8266625150A0910021

10160f10140t10061f10060f10030t0232Tr01380l00400lEDITSCODINGCORRECT20527n20501f20500m15851f12044f12031f12020f12002f12001f11900f11010329085f29075f29065f27370r26340f25259f24300f20553n20552n20551n20550n29505f29425f29405f29365f29355f29345f29260f29240f29130f29125f29105f36405f36400f36000f29584f29583f29582f29581f29580f29540f29530f29515f43752f36640f36600f36592r36591r36440f36430f36425f36420f36410f36406f64416n64415n64413f64410f64408f64405f64402f64400f51703f51702f51701f64448f64447f64446f64445f64435f64430f64425f64421f64420f64418f64417n64510f64508f64505f64489n64488n64487n64486n64463n64461n64450l64449f76882n76080f76001r76000m72295f72265f72255f69990n64530f64520f64517f93041f93040f93010f93005f93000f92014r92012r77001n76998u76970n76942r95812f94770f94690f94681f94680f94250f94200f94002f93355f93318f93042f95912f95911f95910f95909f95908f95907f95829f95822f95819f95816f95813f96375f96374f96372f96368n96367n96366n96365f96361n96360f95955f95913f99217r99215r99214r99213r99212r99211r99157u99156u99155u96377f96376f99235r99234r99233r99232r99231r99223r99222r99221r99220r99219r99218r99253r99252r99251r99245r99244r99243r99242r99241r99239r99238r99236r99310r99309r99308r99307r99306r99305r99304r99292r99291r99255r99254r99374r99350r99349r99348r99347r99337r99336r99335r99334r99316r99315rG0463rG0168f99496r99495r99449r99448r99447r99446r99378r99377r99375r

J2001nJ0670nG0471f

Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder,hip, knee, subacromial bursa); with ultrasound guidance, with permanentrecording and reporting

20611OTHERRELATIVE VALUE UNITS

MUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork4(3)01.772.590.511.330.161.10

INDICATORSMODIFIERSStatusSuprv80,8266625150A0910021

10030t0232Tr0230Tn0228Tn0216Tn0213Tn01380l00400lEDITSCODINGCORRECT12007n12006n12005n12004n12002n12001n11900f10160f10140t10061f10060f12032n12031n12021n12020n12018n12017n12016n12015n12014n12013n12011n12051n12047n12046n12045n12044n12042n12041n12037n12036n12035n12034n13121n13120n13102n13101n13100n12057n12056n12055n12054n12053n12052n20527n20501f20500m15851f13153n13152n13151n13133n13132n13131n13122n29075f29065f27370r26340f25259f24300f20610u20553n20552n20551n20550n29425f29405f29365f29355f29345f29260f29240f29130f29125f29105f29085f36400f36000f29584f29583f29582f29581f29580f29540f29530f29515f29505f36640f36600f36592r36591r36440f36430f36425f36420f36410m36406f36405f62326n62325n62324n62323n62322n62321n62320n51703f51702f51701f43752f64418n64417n64416n64415n64413n64410n64408n64405n64402n64400n62327n64450n64449n64448n64447n64446n64445n64435n64430n64425n64421n64420n64505n64493n64490n64489n64488n64487n64486n64483n64479n64463n64461n76001r76000m72295f72265f72255f69990n64530n64520n64517n64510n64508m77021r77012r77003u77002r77001n76998u76970n76942r76882n76380n76080f94002f93355f93318f93042f93041f93040f93010f93005f93000f92014r92012r95822f95819f95816f95813f95812f94770f94690m94681f94680f94250m94200f96361n96360f95955f95913f95912f95911f95910f95909f95908f95907f95829m99156u99155u96377f96376f96375f96374f96372f96368n96367n96366n96365f99221r99220r99219r99218r99217r99215r99214r99213r99212r99211r99157u99241r99239r99238r99236r99235r99234r99233r99232r99231r99223r99222r99292r99291r99255r99254r99253r99252r99251r99245r99244r99243r99242r99335r99334r99316r99315r99310r99309r99308r99307r99306r99305r99304r99446r99378r99377r99375r99374r99350r99349r99348r99347r99337r99336r

J2001nJ0670nG0471fG0463rG0168f99496r99495r99449r99448r99447r

Aspiration and/or injection of ganglion cyst(s) any location20612OTHERRELATIVE VALUE UNITS

MUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork2(3)01.201.720.410.930.090.70

INDICATORSMODIFIERSStatusSuprv80,8266625150A0910020

10060f10030t0230Tf0228Tf0216Tn0213Tn01820l00400lEDITSCODINGCORRECT12013n12011n12007n12006n12005n12004n12002n12001n10160f10140t10061f12035n12034n12032n12031n12021n12020n12018n12017n12016n12015n12014n12053n12052n12051n12047n12046n12045n12044n12042n12041n12037n12036n13131n13122n13121n13120n13102n13101n13100n12057n12056n12055n12054n20552n20551n20550n20527n20526n20500t13153n13152n13151n13133n13132n36591r36440f36430f36425f36420f36410f36406f36405f36400f36000f20553n62323f62322f62321f62320f51703f51702f51701f43752f36640f36600f36592r64415n64413f64410f64408f64405f64402f64400f62327n62326n62325n62324n64447f64446f64445f64435f64430f64425f64421f64420f64418f64417n64416f64489n64488n64487n64486n64483f64479f64463n64461n64450n64449f64448f76001f76000f69990n64530f64520f64517f64510f64508f64505f64493n64490n93355f93318f93042f93041f93040f93010f93005f93000f92014r92012r77001n95819f95816f95813f95812f94770f94690f94681f94680f94250f94200f94002f96374f96372f96368n96367n96366n96365f96361n96360f95955f95829f95822f99215r99214r99213r99212r99211r99157u99156u99155u96377f96376f96375f99234r99233r99232r99231r99223r99222r99221r99220r99219r99218r99217r99252r99251r99245r99244r99243r99242r99241r99239r99238r99236r99235r99309r99308r99307r99306r99305r99304r99292r99291r99255r99254r99253r99350r99349r99348r99347r99337r99336r99335r99334r99316r99315r99310rG0463r99496r99495r99449r99448r99447r99446r99378r99377r99375r99374r

J2001nJ0670nG0471f

Aspiration and injection for treatment of bone cyst20615OTHERRELATIVE VALUE UNITS

MUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork1(3)104.656.872.014.230.312.33

INDICATORSMODIFIERSStatusSuprv80,8266625150A0910020

12004n12002n12001n1101030230Tf0228Tf0216Tn0213TnEDITSCODINGCORRECT12020n12018n12017n12016n12015n12014n12013n12011n12007n12006n12005n12045n12044n12042n12041n12037n12036n12035n12034n12032n12031n12021n13101n13100n12057n12056n12055n12054n12053n12052n12051n12047n12046n20526n13153n13152n13151n13133n13132n13131n13122n13121n13120n13102n36591r36440f36430f36425f36420f36410f36406f36405f36400f36000f29365f62323f62322f62321f62320f51703f51702f51701f43752f36640f36600f36592r64415n64413f64410f64408f64405f64402f64400f62327n62326n62325n62324n64447f64446f64445f64435f64430f64425f64421f64420f64418f64417n64416n64489n64488n64487n64486n64483f64479f64463n64461n64450n64449f64448f92014r92012r69990n64530f64520f64517f64510f64508f64505f64493n64490n94250f94200f94002f93355f93318f93042f93041f93040f93010f93005f93000f95955f95829f95822f95819f95816f95813f95812f94770f94690f94681f94680f96377f96376f96375f96374f96372f96368n96367n96366n96365f96361n96360f99219r99218r99217r99215r99214r99213r99212r99211r99157u99156u99155u99238r99236r99235r99234r99233r99232r99231r99223r99222r99221r99220r99255r99254r99253r99252r99251r99245r99244r99243r99242r99241r99239r99316r99315r99310r99309r99308r99307r99306r99305r99304r99292r99291r99377r99375r99374r99350r99349r99348r99347r99337r99336r99335r99334r

J2001nG0471fG0463r99496r99495r99449r99448r99447r99446r99378r

Anesthesia Included in Surgical ProcedurelStandard Preparation/Monitoring ServicesPMutually Exclusive Procedures3Sequential ProceduresH

Standards of Medical/Surgical PracticefMisuse of Column 2 with Column 1nLaboratory Panelss

© 2017 Optum360, LLC

d Modifier use may allow separate payment

CPT © 2016 American Medical Association. All Rights Reserved.January 2017Musculoskeletal — 8

Medicare Correct Coding Guide (CCI Version 23.0)Surgery: Musculoskeletal System

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Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorgesyndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternalblood

81422OTHERRELATIVE VALUE UNITS

MUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork—XXX0.000.000.000.000.000.00

INDICATORSMODIFIERSStatusSuprv80,8266625150X0999999

81205n81203n81202n81201n81200n81170n81162n81161nEDITSCODINGCORRECT81216n81215n81214n81213n81212n81211n81210n81209n81208n81207n81206n81227n81226n81225n81224n81223n81222n81221n81220n81219n81218n81217n81250n81246n81245n81244n81243n81242n81241n81240n81235n81229r81228r81263n81262n81261n81260n81257n81256n81255n81254n81253n81252n81251n81287n81276n81275n81273n81272n81270n81268n81267n81266n81265n81264n81299n81298n81297n81296n81295n81294n81293n81292n81291n81290n81288n81316n81315n81314n81313n81311n81310n81304n81303n81302n81301n81300n81330n81327n81326n81325n81324n81323n81322n81321n81319n81318n81317n81403n81402n81401n81400n81355n81350n81342n81341n81340n81332n81331n81528381525381519381507381504381493381408n81407n81406n81405n81404n88364n88291n88275n88274n88273n88272n88271r84311n815953815453815403

G0452n96523r88377n88374n88373n88369n88368n88367n88366n88365n

Genome (eg, unexplained constitutional or heritable disorder or syndrome);sequence analysis81425

OTHERRELATIVE VALUE UNITSMUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork1(1)XXX0.000.000.000.000.000.00

INDICATORSMODIFIERSStatusSuprv80,8266625150X0999999

81205n81203n81202n81201n81200n81170n81162n81161nEDITSCODINGCORRECT81216n81215n81214n81213n81212n81211n81210n81209n81208n81207n81206n81227n81226n81225n81224n81223n81222n81221n81220n81219n81218n81217n81252n81251n81250n81246n81245n81244n81243n81242n81241n81240n81235n81265n81264n81263n81262n81261n81260n81257n81256n81255n81254n81253n81290n81288n81287n81276n81275n81273n81272n81270n81268n81267n81266n81301n81300n81299n81298n81297n81296n81295n81294n81293n81292n81291n81318n81317n81316n81315n81314n81313n81311n81310n81304n81303n81302n81332n81331n81330n81327n81326n81325n81324n81323n81322n81321n81319n81405n81404n81403n81402n81401n81400n81355n81350n81342n81341n81340n81545n81540n81528n81525n81519n81507n81504n81493n81408n81407n81406n88366n88365n88364n88291n88275n88274n88273n88272n88271r84311n81595n

G0452n88377n88374n88373n88369n88368n88367n

Genome (eg, unexplained constitutional or heritable disorder or syndrome);sequence analysis, each comparator genome (eg, parents, siblings) (Listseparately in addition to code for primary procedure)

81426OTHERRELATIVE VALUE UNITS

MUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork2(1)XXX0.000.000.000.000.000.00

INDICATORSMODIFIERSStatusSuprv80,8266625150X0999999

81205n81203n81202n81201n81200n81170n81162n81161nEDITSCODINGCORRECT81216n81215n81214n81213n81212n81211n81210n81209n81208n81207n81206n81227n81226n81225n81224n81223n81222n81221n81220n81219n81218n81217n81252n81251n81250n81246n81245n81244n81243n81242n81241n81240n81235n81265n81264n81263n81262n81261n81260n81257n81256n81255n81254n81253n81290n81288n81287n81276n81275n81273n81272n81270n81268n81267n81266n81301n81300n81299n81298n81297n81296n81295n81294n81293n81292n81291n81318n81317n81316n81315n81314n81313n81311n81310n81304n81303n81302n81332n81331n81330n81327n81326n81325n81324n81323n81322n81321n81319n81405n81404n81403n81402n81401n81400n81355n81350n81342n81341n81340n81545n81540n81528n81525n81519n81507n81504n81493n81408n81407n81406n88366n88365n88364n88291n88275n88274n88273n88272n88271r84311n81595n

G0452n88377n88374n88373n88369n88368n88367n

Genome (eg, unexplained constitutional or heritable disorder or syndrome);re-evaluation of previously obtained genome sequence (eg, updated knowledgeor unrelated condition/syndrome)

81427OTHERRELATIVE VALUE UNITS

MUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork1(1)XXX0.000.000.000.000.000.00

INDICATORSMODIFIERSStatusSuprv80,8266625150X0999999

81205n81203n81202n81201n81200n81170n81162n81161nEDITSCODINGCORRECT81216n81215n81214n81213n81212n81211n81210n81209n81208n81207n81206n81227n81226n81225n81224n81223n81222n81221n81220n81219n81218n81217n81252n81251n81250n81246n81245n81244n81243n81242n81241n81240n81235n81265n81264n81263n81262n81261n81260n81257n81256n81255n81254n81253n81290n81288n81287n81276n81275n81273n81272n81270n81268n81267n81266n81301n81300n81299n81298n81297n81296n81295n81294n81293n81292n81291n81318n81317n81316n81315n81314n81313n81311n81310n81304n81303n81302n81332n81331n81330n81327n81326n81325n81324n81323n81322n81321n81319n81405n81404n81403n81402n81401n81400n81355n81350n81342n81341n81340n81545n81540n81528n81525n81519n81507n81504n81493n81408n81407n81406n88366n88365n88364n88291n88275n88274n88273n88272n88271r84311n81595n

G0452n88377n88374n88373n88369n88368n88367n

Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendredsyndrome); genomic sequence analysis panel, must include sequencing of atleast 60 genes, including CDH23, CLRN1, GJB2, GPR98, MTRNR1, MYO7A,MYO15A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C, USH1G,USH2A, and WFS1

81430

OTHERRELATIVE VALUE UNITSMUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork1(2)XXX0.000.000.000.000.000.00

INDICATORSMODIFIERSStatusSuprv80,8266625150X0999999

81205n81203n81202n81201n81200n81170n81162n81161nEDITSCODINGCORRECT81216n81215n81214n81213n81212n81211n81210n81209n81208n81207n81206n81227n81226n81225n81224n81223n81222n81221n81220n81219n81218n81217n81252n81251n81250n81246n81245n81244n81243n81242n81241n81240n81235n81265n81264n81263n81262n81261n81260n81257n81256n81255n81254n81253n81290n81288n81287n81276n81275n81273n81272n81270n81268n81267n81266n81301n81300n81299n81298n81297n81296n81295n81294n81293n81292n81291n81318n81317n81316n81315n81314n81313n81311n81310n81304n81303n81302n81332n81331n81330n81327n81326n81325n81324n81323n81322n81321n81319n81405n81404n81403n81402n81401n81400n81355n81350n81342n81341n81340n81545n81540n81528n81525n81519n81507n81504n81493n81408n81407n81406n88366n88365n88364n88291n88275n88274n88273n88272n88271r84311n81595n

G0452n88377n88374n88373n88369n88368n88367n

Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendredsyndrome); duplication/deletion analysis panel, must include copy numberanalyses for STRC and DFNB1 deletions in GJB2 and GJB6 genes

81431OTHERRELATIVE VALUE UNITS

MUEGlobal PTotal-fTotal-nfPE-fPE-nfMPWork1(2)XXX0.000.000.000.000.000.00

INDICATORSMODIFIERSStatusSuprv80,8266625150X0999999

81205n81203n81202n81201n81200n81170n81162n81161nEDITSCODINGCORRECT81216n81215n81214n81213n81212n81211n81210n81209n81208n81207n81206n81227n81226n81225n81224n81223n81222n81221n81220n81219n81218n81217n81252n81251n81250n81246n81245n81244n81243n81242n81241n81240n81235n81265n81264n81263n81262n81261n81260n81257n81256n81255n81254n81253n81290n81288n81287n81276n81275n81273n81272n81270n81268n81267n81266n81301n81300n81299n81298n81297n81296n81295n81294n81293n81292n81291n81318n81317n81316n81315n81314n81313n81311n81310n81304n81303n81302n81332n81331n81330n81327n81326n81325n81324n81323n81322n81321n81319n81405n81404n81403n81402n81401n81400n81355n81350n81342n81341n81340n81545n81540n81528n81525n81519n81507n81504n81493n81408n81407n81406n88366n88365n88364n88291n88275n88274n88273n88272n88271r84311n81595n

G0452n88377n88374n88373n88369n88368n88367n

More Extensive ProceduretCPT Separate Procedure DefinitionmDesignation of Gender-specific Procedures´

MUE 3 DOS Edit: ClinicalMUE 2 DOS Edit: PolicyMUE 1 Line Edit

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