Search This Blog

Pneumococcal Vaccine and Administration

HCPCS/CPT Codes

  • 90670 – Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
  • 90732 – Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
  • G0009 – Pneumococcal Administration

ICD-10 Codes

The specified below ICD codes are covered for CPT G0102 and G0103 but may not be limited and some private payers having specific guidelines.
  • Z23         Encounter for immunization
  • Z71.84 Encounter for health counseling related to travel

Who Is Covered

  • All Medicare beneficiaries

Fee Value and MUE Edits

      CPT         Dosage   Fee    MUE
      90670 0.5 ml $241.383 1
      90732 0.5 ml $125.918 1

Frequency

  • An initial pneumococcal vaccine to Medicare beneficiaries who never received the vaccine under Medicare Part B
  • A different, second pneumococcal vaccine 1 year after the first vaccine was administered

Medicare Beneficiary Pays

  • Copayment/coinsurance waived
  • Deductible waived

Prostate Cancer Screening CPT G0102 and G0103

HCPCS/CPT Codes

G0102 – Prostate cancer screening; digital rectal examination

  • The Physician performs a prostate cancer screening in which he performs a digital rectal examination to assess the male patient’s prostate. 
  • To examine the prostate the provider inserts a gloved and lubricated finger into the rectum and checks for hardness, lumps, or any abnormalities. 
  • This examination helps detect prostate cancer in its early stages. The provider typically performs this test for the first time at the age of 40 for men at risk of having prostate cancer such as those men with a family history of cancer
  • Medicare provides coverage for an annual prostate cancer screening digital rectal examination for men at the age of 50.  

      G0103 – Prostate cancer screening; prostate specific antigen test (PSA)

      • The Prostate screening examination, the Physician detects the prostate specific antigen, or PSA, level in a patient’s blood. PSA is a protein the prostate gland produces, and he/she may use PSA levels to screen for prostate cancer
      • This protein is considered as an indicator for prostate cancer. The Physician collects the blood sample through a venipuncture. This test helps to detect prostate cancer in its early stages. 
      • A normal level of PSA in blood level as specified below, 
        • For below 50 years of age is less than 2.5
        • For age 50 to 60 it is less than 3.5, 
        • For age 60 to 70 it is less than 4.5 
        • For age above 70 it is 6.6.  
      • Medicare provides coverage for an annual prostate cancer screening, or PSA, test for men at the age of 50.

        ICD-10 Codes

        The specified below ICD codes are covered for CPT G0102 and G0103 but may not be limited and some private payers having specific guidelines.
        • D07.5 Carcinoma in situ of prostate
        • D29.1 Benign neoplasm of prostate
        • D40.0 Neoplasm of uncertain behavior of prostate
        • R97.20 Elevated prostate specific antigen [PSA]
        • R97.21 Rising PSA following treatment for malignant neoplasm of prostate
        • Z12.5 Encounter for screening for malignant neoplasm of prostate
        • Z15.03 Genetic susceptibility to malignant neoplasm of prostate
        • Z71.84 Encounter for health counseling related to travel
        • Z80.42 Family history of malignant neoplasm of prostate
        • Z85.46 Personal history of malignant neoplasm of prostate

                        Who Is Covered

                        • All male Medicare beneficiaries aged 50 and older (coverage begins the day after their 50th birthday)

                        Frequency

                        • Annually for covered Medicare beneficiaries
                        • Medicare Beneficiary Pays
                        G0102:
                        • Copayment/coinsurance applies
                        • Deductible applies
                        G0103:
                        • Copayment/coinsurance waived
                        • Deductible waived

                        Initial Preventive Physical Examination with EKG (IPPE)

                        Welcome to Medicare Preventive Visit

                        HCPCS/CPT Codes

                        • G0402 – Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
                        • G0403 – Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
                        • G0404 – Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
                        • G0405 – Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

                        Who Is Covered

                        • All new Medicare beneficiaries who are within the first 12 months of their first Medicare Part B coverage period

                        Frequency

                        • Once in a lifetime
                        • Must furnish no later than 12 months after the effective date of the first Medicare Part B coverage period

                        Covered ICD-10 Codes for CPT G0402

                        The specified below ICD codes are covered for CPT G0402 but may not be limited and some private payers having specific guidelines.

                        • R93.811 Abnormal radiologic findings on diagnostic imaging of right testicle
                        • R93.812 Abnormal radiologic findings on diagnostic imaging of left testicle
                        • R93.813 Abnormal radiologic findings on diagnostic imaging of testicles, bilateral
                        • R93.819 Abnormal radiologic findings on diagnostic imaging of unspecified testicle
                        • R93.89 Abnormal findings on diagnostic imaging of other specified body structures
                        • Z00.00 Encounter for general adult medical examination without abnormal findings
                        • Z00.01 Encounter for general adult medical examination with abnormal findings
                        • Z00.8 Encounter for other general examination
                        • Z01.00 Encounter for examination of eyes and vision without abnormal findings
                        • Z01.01 Encounter for examination of eyes and vision with abnormal findings
                        • Z01.020 Encounter for examination of eyes and vision following failed vision screening without abnormal findings
                        • Z01.021 Encounter for examination of eyes and vision following failed vision screening with abnormal findings
                        • Z01.10 Encounter for examination of ears and hearing without abnormal findings
                        • Z01.110 Encounter for hearing examination following failed hearing screening
                        • Z01.118 Encounter for examination of ears and hearing with other abnormal findings
                        • Z68.1 Body mass index [BMI] 19.9 or less, adult
                        • Z68.20 Body mass index [BMI] 20.0-20.9, adult
                        • Z68.21 Body mass index [BMI] 21.0-21.9, adult
                        • Z68.22 Body mass index [BMI] 22.0-22.9, adult
                        • Z68.23 Body mass index [BMI] 23.0-23.9, adult
                        • Z68.24 Body mass index [BMI] 24.0-24.9, adult
                        • Z68.25 Body mass index [BMI] 25.0-25.9, adult
                        • Z68.26 Body mass index [BMI] 26.0-26.9, adult
                        • Z68.27 Body mass index [BMI] 27.0-27.9, adult
                        • Z68.28 Body mass index [BMI] 28.0-28.9, adult
                        • Z68.29 Body mass index [BMI] 29.0-29.9, adult
                        • Z68.30 Body mass index [BMI] 30.0-30.9, adult
                        • Z68.31 Body mass index [BMI] 31.0-31.9, adult
                        • Z68.32 Body mass index [BMI] 32.0-32.9, adult
                        • Z68.33 Body mass index [BMI] 33.0-33.9, adult
                        • Z68.34 Body mass index [BMI] 34.0-34.9, adult
                        • Z68.35 Body mass index [BMI] 35.0-35.9, adult
                        • Z68.36 Body mass index [BMI] 36.0-36.9, adult
                        • Z68.37 Body mass index [BMI] 37.0-37.9, adult
                        • Z68.38 Body mass index [BMI] 38.0-38.9, adult
                        • Z68.39 Body mass index [BMI] 39.0-39.9, adult
                        • Z68.41 Body mass index [BMI] 40.0-44.9, adult
                        • Z68.42 Body mass index [BMI] 45.0-49.9, adult
                        • Z68.43 Body mass index [BMI] 50.0-59.9, adult
                        • Z68.44 Body mass index [BMI] 60.0-69.9, adult
                        • Z68.45 Body mass index [BMI] 70 or greater, adult
                        • Z71.84 Encounter for health counseling related to travel

                        Covered ICD-10 Codes for CPT G0403, G0404, G0405

                        The specified below ICD codes are covered for CPT G0403, G0404, G0405 but may not be limited and some private payers having specific guidelines.
                        • R00.0 Tachycardia, unspecified
                        • R00.1 Bradycardia, unspecified
                        • R00.2 Palpitations
                        • R00.8 Other abnormalities of heart beat
                        • R00.9 Unspecified abnormalities of heart beat
                        • R01.0 Benign and innocent cardiac murmurs
                        • R01.1 Cardiac murmur, unspecified
                        • R01.2 Other cardiac sounds
                        • R03.0 Elevated blood-pressure reading, without diagnosis of hypertension
                        • R07.1 Chest pain on breathing
                        • R07.2 Precordial pain
                        • R07.81 Pleurodynia
                        • R07.82 Intercostal pain
                        • R07.89 Other chest pain
                        • R07.9 Chest pain, unspecified
                        • R94.31 Abnormal electrocardiogram [ECG] [EKG]
                        • Z13.30 Encounter for screening examination for mental health and behavioral disorders, unspecified
                        • Z13.31 Encounter for screening for depression
                        • Z13.32 Encounter for screening for maternal depression
                        • Z13.39 Encounter for screening examination for other mental health and behavioral disorders
                        • Z13.6 Encounter for screening for cardiovascular disorders
                        • Z82.41 Family history of sudden cardiac death
                        • Z82.49 Family history of ischemic heart disease and other diseases of the circulatory system

                        Medicare Beneficiary Pays as below,

                        G0402,

                        • Copayment/coinsurance waived
                        • Deductible waived

                        G0403, G0404, and G0405,

                        • Copayment/coinsurance applies
                        • Deductible applies

                        Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests

                        Human Papillomavirus 

                        The lab analyst performs the technical steps to detect human papillomavirus through nucleic acid detection and the Nucleic acid probes permit identification of microorganisms based on their DNA or RNA. 

                        The Nucleic acid quantitation allows assessment of treatment response and the Quantitation refers to measuring the exact amount of a substance. The lab analyst performs this procedure for detection of high risk types of human papillomavirus.

                         HCPCS/CPT Codes

                        • G0476 – Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test 

                        ICD-10 Codes

                        The specified below ICD codes are covered for CPT G0476 but may not be limited and some private payers having specific guidelines.

                        • B97.7 Papillomavirus as the cause of diseases classified elsewhere
                        • R85.81 Anal high risk human papillomavirus (HPV) DNA test positive
                        • R85.82 Anal low risk human papillomavirus (HPV) DNA test positive
                        • R87.810 Cervical high risk human papillomavirus (HPV) DNA test positive
                        • R87.811 Vaginal high risk human papillomavirus (HPV) DNA test positive
                        • R87.820 Cervical low risk human papillomavirus (HPV) DNA test positive
                        • R87.821 Vaginal low risk human papillomavirus (HPV) DNA test positive
                        • Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings
                        • Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings
                        • Z01.42 Encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear
                        • Z11.51 Encounter for screening for human papillomavirus (HPV)
                        • Z86.002 Personal history of in-situ neoplasm of other and unspecified genital organs

                        Who Is Covered

                        • All asymptomatic female Medicare beneficiaries aged 30 to 65 years

                        Frequency

                        • Once every 5 years

                        Medicare Beneficiary Pays

                        • Copayment/coinsurance waived
                        • Deductible waived

                        Intensive Behavioral Therapy (IBT) - CPT G0446

                        Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)

                        • Also known as a CVD risk reduction visit

                        HCPCS/CPT Codes

                        • G0446 – Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes

                        Covered ICD Codes

                        The specified below ICD  codes are covered for CPT G0446 but may not be limited and some private payers having specific guidelines.

                        • F53.0    Postpartum depression
                        • F53.1    Puerperal psychosis 
                        • F68.A    Factitious disorder imposed on another
                        • I01.0 Acute rheumatic pericarditis
                        • I01.1 Acute rheumatic endocarditis
                        • I01.2 Acute rheumatic myocarditis
                        • I01.8 Other acute rheumatic heart disease
                        • I01.9 Acute rheumatic heart disease, unspecified
                        • I02.0 Rheumatic chorea with heart involvement
                        • I02.9 Rheumatic chorea without heart involvement
                        • I05.0 Rheumatic mitral stenosis
                        • I05.1 Rheumatic mitral insufficiency
                        • I05.2 Rheumatic mitral stenosis with insufficiency
                        • I05.8 Other rheumatic mitral valve diseases
                        • I05.9 Rheumatic mitral valve disease, unspecified
                        • I06.0 Rheumatic aortic stenosis
                        • I06.1 Rheumatic aortic insufficiency
                        • I06.2 Rheumatic aortic stenosis with insufficiency
                        • I06.8 Other rheumatic aortic valve diseases
                        • I06.9 Rheumatic aortic valve disease, unspecified
                        • I07.0 Rheumatic tricuspid stenosis
                        • I07.1 Rheumatic tricuspid insufficiency
                        • I07.2 Rheumatic tricuspid stenosis and insufficiency
                        • I07.8 Other rheumatic tricuspid valve diseases
                        • I07.9 Rheumatic tricuspid valve disease, unspecified
                        • I08.0 Rheumatic disorders of both mitral and aortic valves
                        • I08.1 Rheumatic disorders of both mitral and tricuspid valves
                        • I08.2 Rheumatic disorders of both aortic and tricuspid valves
                        • I08.3 Combined rheumatic disorders of mitral, aortic and tricuspid valves
                        • I08.8 Other rheumatic multiple valve diseases
                        • I08.9 Rheumatic multiple valve disease, unspecified
                        • I09.0 Rheumatic myocarditis
                        • I09.1 Rheumatic diseases of endocardium, valve unspecified
                        • I09.2 Chronic rheumatic pericarditis
                        • I09.81 Rheumatic heart failure
                        • I09.89 Other specified rheumatic heart diseases
                        • I09.9 Rheumatic heart disease, unspecified
                        • I10         Essential (primary) hypertension
                        • I11.0 Hypertensive heart disease with heart failure
                        • I11.9 Hypertensive heart disease without heart failure
                        • I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
                        • I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
                        • I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
                        • I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
                        • I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
                        • I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
                        • I15.0 Renovascular hypertension
                        • I15.1 Hypertension secondary to other renal disorders
                        • I15.2 Hypertension secondary to endocrine disorders
                        • I15.8 Other secondary hypertension
                        • I15.9 Secondary hypertension, unspecified
                        • I16.0 Hypertensive urgency
                        • I16.1 Hypertensive emergency
                        • I16.9 Hypertensive crisis, unspecified
                        • I20.0 Unstable angina
                        • I20.1 Angina pectoris with documented spasm
                        • I20.8 Other forms of angina pectoris
                        • I20.9 Angina pectoris, unspecified
                        • I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
                        • I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
                        • I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
                        • I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
                        • I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
                        • I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
                        • I21.29 ST elevation (STEMI) myocardial infarction involving other sites
                        • I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
                        • I21.4 Non-ST elevation (NSTEMI) myocardial infarction
                        • I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
                        • I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
                        • I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
                        • I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
                        • I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
                        • I23.0 Hemopericardium as current complication following acute myocardial infarction
                        • I23.1 Atrial septal defect as current complication following acute myocardial infarction
                        • I23.2 Ventricular septal defect as current complication following acute myocardial infarction
                        • I23.3 Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction
                        • I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction
                        • I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction
                        • I23.6 Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction
                        • I23.7 Postinfarction angina
                        • I23.8 Other current complications following acute myocardial infarction
                        • I24.0 Acute coronary thrombosis not resulting in myocardial infarction
                        • I24.1 Dressler's syndrome
                        • I24.8 Other forms of acute ischemic heart disease
                        • I24.9 Acute ischemic heart disease, unspecified
                        • I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
                        • I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
                        • I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
                        • I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
                        • I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
                        • I25.2 Old myocardial infarction
                        • I25.3 Aneurysm of heart
                        • I25.41 Coronary artery aneurysm
                        • I25.42 Coronary artery dissection
                        • I25.5 Ischemic cardiomyopathy
                        • I25.6 Silent myocardial ischemia
                        • I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
                        • I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
                        • I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
                        • I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
                        • I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
                        • I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
                        • I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
                        • I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
                        • I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
                        • I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
                        • I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
                        • I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
                        • I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
                        • I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
                        • I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
                        • I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
                        • I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
                        • I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
                        • I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
                        • I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
                        • I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
                        • I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
                        • I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
                        • I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
                        • I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
                        • I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
                        • I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
                        • I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
                        • I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
                        • I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
                        • I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
                        • I25.82 Chronic total occlusion of coronary artery
                        • I25.83 Coronary atherosclerosis due to lipid rich plaque
                        • I25.84 Coronary atherosclerosis due to calcified coronary lesion
                        • I25.89 Other forms of chronic ischemic heart disease
                        • I25.9 Chronic ischemic heart disease, unspecified
                        • I26.01 Septic pulmonary embolism with acute cor pulmonale
                        • I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
                        • I26.09 Other pulmonary embolism with acute cor pulmonale
                        • I26.90 Septic pulmonary embolism without acute cor pulmonale
                        • I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
                        • I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
                        • I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
                        • I26.99 Other pulmonary embolism without acute cor pulmonale
                        • I27.0 Primary pulmonary hypertension
                        • I27.1 Kyphoscoliotic heart disease
                        • I27.81 Cor pulmonale (chronic)
                        • I27.82 Chronic pulmonary embolism
                        • I27.89 Other specified pulmonary heart diseases
                        • I27.9 Pulmonary heart disease, unspecified
                        • I28.0 Arteriovenous fistula of pulmonary vessels
                        • I28.1 Aneurysm of pulmonary artery
                        • I28.8 Other diseases of pulmonary vessels
                        • I28.9 Disease of pulmonary vessels, unspecified
                        • I30.0 Acute nonspecific idiopathic pericarditis
                        • I30.1 Infective pericarditis
                        • I30.8 Other forms of acute pericarditis
                        • I30.9 Acute pericarditis, unspecified
                        • I31.0 Chronic adhesive pericarditis
                        • I31.1 Chronic constrictive pericarditis
                        • I31.2 Hemopericardium, not elsewhere classified
                        • I31.3 Pericardial effusion (noninflammatory)
                        • I31.4 Cardiac tamponade
                        • I31.8 Other specified diseases of pericardium
                        • I31.9 Disease of pericardium, unspecified
                        • I32         Pericarditis in diseases classified elsewhere
                        • I33.0 Acute and subacute infective endocarditis
                        • I33.9 Acute and subacute endocarditis, unspecified 
                        • I34.0 Nonrheumatic mitral (valve) insufficiency
                        • I34.1 Nonrheumatic mitral (valve) prolapse
                        • I34.2 Nonrheumatic mitral (valve) stenosis
                        • I34.8 Other nonrheumatic mitral valve disorders
                        • I34.9 Nonrheumatic mitral valve disorder, unspecified
                        • I35.0 Nonrheumatic aortic (valve) stenosis
                        • I35.1 Nonrheumatic aortic (valve) insufficiency
                        • I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
                        • I35.8 Other nonrheumatic aortic valve disorders
                        • I35.9 Nonrheumatic aortic valve disorder, unspecified
                        • I36.0 Nonrheumatic tricuspid (valve) stenosis
                        • I36.1 Nonrheumatic tricuspid (valve) insufficiency
                        • I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency
                        • I36.8 Other nonrheumatic tricuspid valve disorders
                        • I36.9 Nonrheumatic tricuspid valve disorder, unspecified
                        • I37.0 Nonrheumatic pulmonary valve stenosis
                        • I37.1 Nonrheumatic pulmonary valve insufficiency
                        • I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency
                        • I37.8 Other nonrheumatic pulmonary valve disorders
                        • I37.9 Nonrheumatic pulmonary valve disorder, unspecified
                        • I38         Endocarditis, valve unspecified
                        • I39         Endocarditis and heart valve disorders in diseases classified elsewhere
                        • I40.0 Infective myocarditis
                        • I40.1 Isolated myocarditis
                        • I40.8 Other acute myocarditis
                        • I40.9 Acute myocarditis, unspecified
                        • I41         Myocarditis in diseases classified elsewhere
                        • I42.0 Dilated cardiomyopathy
                        • I42.1 Obstructive hypertrophic cardiomyopathy
                        • I42.2 Other hypertrophic cardiomyopathy
                        • I42.3 Endomyocardial (eosinophilic) disease
                        • I42.4 Endocardial fibroelastosis
                        • I42.5 Other restrictive cardiomyopathy
                        • I42.6 Alcoholic cardiomyopathy
                        • I42.7 Cardiomyopathy due to drug and external agent
                        • I42.8 Other cardiomyopathies
                        • I42.9 Cardiomyopathy, unspecified
                        • I43         Cardiomyopathy in diseases classified elsewhere
                        • I44.0 Atrioventricular block, first degree
                        • I44.1 Atrioventricular block, second degree
                        • I44.2 Atrioventricular block, complete
                        • I44.30 Unspecified atrioventricular block
                        • I44.39 Other atrioventricular block
                        • I44.4 Left anterior fascicular block
                        • I44.5 Left posterior fascicular block
                        • I44.60 Unspecified fascicular block
                        • I44.69 Other fascicular block
                        • I44.7 Left bundle-branch block, unspecified
                        • I45.0 Right fascicular block
                        • I45.10 Unspecified right bundle-branch block
                        • I45.19 Other right bundle-branch block
                        • I45.2 Bifascicular block
                        • I45.3 Trifascicular block
                        • I45.4 Nonspecific intraventricular block
                        • I45.5 Other specified heart block
                        • I45.6 Pre-excitation syndrome
                        • I45.81 Long QT syndrome
                        • I45.89 Other specified conduction disorders
                        • I45.9 Conduction disorder, unspecified
                        • I46.2 Cardiac arrest due to underlying cardiac condition
                        • I46.8 Cardiac arrest due to other underlying condition
                        • I46.9 Cardiac arrest, cause unspecified
                        • I47.0 Re-entry ventricular arrhythmia
                        • I47.1 Supraventricular tachycardia
                        • I47.2 Ventricular tachycardia
                        • I47.9 Paroxysmal tachycardia, unspecified
                        • I48.0 Paroxysmal atrial fibrillation
                        • I48.11 Longstanding persistent atrial fibrillation
                        • I48.19 Other persistent atrial fibrillation
                        • I48.20 Chronic atrial fibrillation, unspecified
                        • I48.21 Permanent atrial fibrillation
                        • I48.3 Typical atrial flutter
                        • I48.4 Atypical atrial flutter
                        • I48.91 Unspecified atrial fibrillation
                        • I48.92 Unspecified atrial flutter
                        • I49.01 Ventricular fibrillation
                        • I49.02 Ventricular flutter
                        • I49.1 Atrial premature depolarization
                        • I49.2 Junctional premature depolarization
                        • I49.3 Ventricular premature depolarization
                        • I49.40 Unspecified premature depolarization
                        • I49.49 Other premature depolarization
                        • I49.5 Sick sinus syndrome
                        • I49.8 Other specified cardiac arrhythmias
                        • I49.9 Cardiac arrhythmia, unspecified
                        • I50.1 Left ventricular failure, unspecified
                        • I50.20 Unspecified systolic (congestive) heart failure
                        • I50.21 Acute systolic (congestive) heart failure
                        • I50.22 Chronic systolic (congestive) heart failure
                        • I50.23 Acute on chronic systolic (congestive) heart failure
                        • I50.30 Unspecified diastolic (congestive) heart failure
                        • I50.31 Acute diastolic (congestive) heart failure
                        • I50.32 Chronic diastolic (congestive) heart failure
                        • I50.33 Acute on chronic diastolic (congestive) heart failure
                        • I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
                        • I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
                        • I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
                        • I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
                        • I50.9 Heart failure, unspecified
                        • I51.0 Cardiac septal defect, acquired
                        • I51.1 Rupture of chordae tendineae, not elsewhere classified
                        • I51.2 Rupture of papillary muscle, not elsewhere classified
                        • I51.3 Intracardiac thrombosis, not elsewhere classified
                        • I51.4 Myocarditis, unspecified
                        • I51.5 Myocardial degeneration
                        • I51.7 Cardiomegaly
                        • I51.81 Takotsubo syndrome
                        • I51.89 Other ill-defined heart diseases
                        • I51.9 Heart disease, unspecified
                        • I52         Other heart disorders in diseases classified elsewhere
                        • Z13.30 Encounter for screening examination for mental health and behavioral disorders, unspecified
                        • Z13.31 Encounter for screening for depression
                        • Z13.32 Encounter for screening for maternal depression
                        • Z13.39 Encounter for screening examination for other mental health and behavioral disorders

                        Who Is Covered

                        All Medicare beneficiaries covered when following criteria are met,

                        • Competent and alert at the time counseling is provided
                        • Furnished counseling by a qualified primary care physician or other primary care practitioner and in a primary care setting

                        Frequency

                        • Annually for covered Medicare beneficiaries

                        Medicare Beneficiary Pays

                        • Copayment/coinsurance waived
                        • Deductible waived

                        Intensive Behavioral Therapy (IBT) for Obesity

                        HCPCS/CPT Codes

                        • G0447 – Face-to-face behavioral counseling for obesity, 15 minutes
                        • G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes

                        Covered ICD-10 Codes for CPT G0447 & G0473

                        The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,

                        • Z68.30 - Body mass index [BMI] 30.0-30.9, adult
                        • Z68.31  -Body mass index [BMI] 31.0-31.9, adult
                        • Z68.32 - Body mass index [BMI] 32.0-32.9, adult
                        • Z68.33 - Body mass index [BMI] 33.0-33.9, adult
                        • Z68.34 - Body mass index [BMI] 34.0-34.9, adult
                        • Z68.35 - Body mass index [BMI] 35.0-35.9, adult
                        • Z68.36 - Body mass index [BMI] 36.0-36.9, adult
                        • Z68.37 - Body mass index [BMI] 37.0-37.9, adult
                        • Z68.38 - Body mass index [BMI] 38.0-38.9, adult
                        • Z68.39 - Body mass index [BMI] 39.0-39.9, adult
                        • Z68.41 - Body mass index [BMI] 40.0-44.9, adult
                        • Z68.42 - Body mass index [BMI] 45.0-49.9, adult
                        • Z68.43 - Body mass index [BMI] 50.0-59.9, adult
                        • Z68.44 - Body mass index [BMI] 60.0-69.9, adult
                        • Z68.45 - Body mass index [BMI] 70 or greater, adult
                        Require primary ICD Codes for above diagnosis,
                        • E66.9 - Obesity, unspecified
                        • E66.8 - Other obesity
                        • E66.3 - Overweight
                        • E66.2 - Morbid (severe) obesity with alveolar hypoventilation
                        • E66.1 - Drug-induced obesity
                        • E66.09 - Other obesity due to excess calories
                        • E66.01 - Morbid (severe) obesity due to excess calories

                        Who Is Covered

                        The Medicare beneficiaries requires the following information to meat the medical necessity 

                        • Obesity (Body Mass Index [BMI] ≥ 30 kilograms [kg] per meter squared)
                        • Competent and alert at the time counseling is provided
                        • Counseling furnished by a qualified primary care physician or other primary care practitioner in a primary care setting

                        Frequency

                        • First month: one face-to-face visit every week
                        • Months 2–6: one face-to-face visit every other week
                        • Months 7–12: one face-to-face visit every month if certain requirements are met.

                        At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.

                        To be eligible for additional face-to-face visits occurring once a month for an additional 6 months, Medicare beneficiaries must have lost at least 3 kg.

                        For Medicare beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.

                        Medicare Beneficiary Pays

                        • Copayment/coinsurance waived
                        • Deductible waived

                        Admission Type with Abbreviation - Place Of Service (POS)

                        PLACE OF SERVICE - PATIENT TYPES 

                        • IN - INPATIENT (POS - 21) - A patient who is assigned a room and bed and receives automatic room/bed charges. 
                        • INO - OBSERVATION (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge. 
                        • OBS - OBSERVATION (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge. 
                        • TELE - TELEMETRY (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge and continuous monitoring. 
                        • SDC - SURGICAL DAY CARE (POS - 22) - A patient who visits the hospital for outpatient surgery. 
                        • SDS - SAME DAY SURGERY (POS - 22) - A patient who visits the hospital for outpatient surgery. 
                        • RCR - RECURRING (POS - 22) - An outpatient who returns to the hospital more than two times for related treatments (a series patient).
                        • ER - EMERGENCY (POS - 23) - An outpatient who comes to the hospital unscheduled and is treated in the emergency room. 
                        • CLI - CLINICAL (POS - 11) - Used for outpatient visits (Lab, Radiology, Respiratory Therapy, Same Day Procedure, NST, OB Check). 
                          • If the service rendered in Hospital than should be used "POS - 22" 

                        ICD 10 CM Updates

                        New Rules for CPT Category III T Codes

                        Attach the Medical Records at initial Claim Submission Please note that when submitting your initial claim for any one of the CPT codes spec...