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Showing posts with label HCPCS. Show all posts
Showing posts with label HCPCS. Show all posts

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 specified below, it is imperative to include documentation for Medicare, your Medicare HMO plan, and any Medicare Advantage insurances. 

These documents are required for processing your claim efficiently. Failure to provide these documents may result in delays or rejection and or denials of your claims.

First Coast Service Options' Medicare, FCSO, requests the following documentation to accompany the initial claim submission for the specified T codes effective from February 26, 2024. In cases where records are not submitted to support the billed code, the service will be rejected and will not be processed. Consequently, the claim must be resubmitted with the appropriate documentation,

  • History and physical examination
  • Lab/Diagnostic test results, if applicable
  • Progress or office notes for the service performed
  • Operative or procedure report, if applicable
  • Full text peer reviewed articles
  • Society guidelines
  • Any additional documentation that supports the need for the service
0174T - Computer algorithm analysis of digital image data
0175T - Remote computer algorithm analysis of digital image data
0253T - Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the suprachoroidal space
0263T - Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure
0264T - Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure excluding bone marrow harvest
0265T - Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; unilateral or bilateral bone marrow harvest only for intramuscular autologous bone marrow cell therapy
0333T - Visual evoked potential, screening of visual acuity, automated, with report
0335T - Insertion of sinus tarsi implant
0338T - Destruction of nerves of arteries of both kidneys accessed through the skin with fluoroscopy and radiological supervision and interpretation
0339T - Destruction of nerves of arteries of one kidney accessed through the skin with fluoroscopy and radiological supervision and interpretation
0342T - Therapeutic apheresis with selective hdl delipidation and plasma reinfusion
0345T - Transcatheter mitral valve repair percutaneous approach via the coronary sinus
0373T - Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior.
0379T -  Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; technical support and patient instructions, surveillance, analysis, and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional
0402T - Collagen cross-linking of cornea, including removal of the corneal epithelium, when performed, and intraoperative pachymetry, when performed
0403T -  Preventive behavior change, intensive program of prevention of diabetes using a standardized diabetes prevention program curriculum, provided to individuals in a group setting, minimum 60 minutes, per day
0422T - Tactile breast imaging by computer-aided tactile sensors, unilateral or bilateral
0443T - Real-time spectral analysis of prostate tissue by fluorescence spectroscopy, including imaging guidance (List separately in addition to code for primary procedure)
0444T - Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral
0445T - Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including re-training, and removal of existing insert, unilateral or bilateral
0446T - Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training
0447T - Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision
0448T - Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation
0450T - Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; each additional device (List separately in addition to code for primary procedure)
0469T - Retinal polarization scan, ocular screening with on-site automated results, bilateral
0474T - Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space
0481T - Injection(s), autologous white blood cell concentrate (autologous protein solution), any site, including image guidance, harvesting and preparation, when performed
0489T - Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; adipose tissue harvesting, isolation and preparation of harvested cells including incubation with cell dissociation enzymes, removal of non-viable cells and debris, determination of concentration and dilution of regenerative cells
0490T - Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; multiple injections in one or both hands
0494T - Surgical preparation and cannulation of marginal (extended) cadaver donor lung(s) to ex vivo organ perfusion system, including decannulation, separation from the perfusion system, and cold preservation of the allograft prior to implantation, when performed
0495T - Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and laboratory assessment (eg, pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance and perfusate gas analysis), including bronchoscopy and X ray when performed; first two hours in sterile field
0496T - Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and laboratory assessment (eg, pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance and perfusate gas analysis), including bronchoscopy and X ray when performed; each additional hour (List separately in addition to code for primary procedure)
0505T - Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed, with crossing of the occlusive lesion in an extraluminal fashion
0506T - Macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report
0509T - Electroretinography (ERG) with interpretation and report, pattern (PERG)
0511T - Removal and reinsertion of sinus tarsi implant
0541T - Imaging of heart muscle using magnetocardiography to detect deficient blood flow, single study
0542T - Interpretation and report of imaging of heart muscle using magnetocardiography to detect deficient blood flow
0547T - Bone material quality testing by microindentations of shin bone
0554T - Bone strength and fracture risk assessment: retrieval and transmission of CT scan data, assessment of bone strength and fracture risk and bone mineral density, interpretation and report
0555T - Bone strength and fracture risk assessment: retrieval and transmission of CT scan data only
0556T - Bone strength and fracture risk assessment: assessment of bone strength and fracture risk and bone mineral density
0557T - Bone strength and fracture risk assessment: interpretation and report
0558T - CT scan for biomechanical computed tomography analysis
0559T - Anatomic model 3D-printed from image data set(s); first individually prepared and processed component of an anatomic structure
0560T - Anatomic model 3D-printed from image data set(s); each additional individually prepared and processed component of an anatomic structure (List separately in addition to code for primary procedure)
0561T - Anatomic guide 3D-printed and designed from image data set(s); first anatomic guide
0562T - Anatomic guide 3D-printed and designed from image data set(s); each additional anatomic guide (List separately in addition to code for primary procedure)
0564T - Evaluation of toxicity of chemotherapy drugs on cancer stem cells
0567T - Blockage of fallopian tubes with implants inserted through cervix
0568T - Introduction of saline and air into fallopian tubes to test for blockage
0583T - Tympanostomy (requiring insertion of ventilating tube), using an automated tube delivery system, iontophoresis local anesthesia
0584T - Transplantation of insulin-producing cells, via catheter accessed through skin using imaging guidance
0585T - Transplantation of insulin-producing cells using endoscope inserted through wall of abdomen
0586T - Transplantation of insulin-producing cells, open procedure
0591T - Face-to-face health and well-being coaching of individual, initial assessment
0592T - Face-to-face health and well-being coaching of individual, follow-up session, at least 30 minutes
0593T - Face-to-face health and well-being coaching of group, at least 30 minutes
0594T - Incision of upper arm bone and insertion of bone-lengthening device in marrow cavity
0602T - Measurement of kidney filtration rate using skin sensor and single dose of fluorescent agent
0603T - Monitoring of kidney filtration rate using skin sensor and multiple doses of fluorescent agent
0610T - Transmission of MR spectroscopy data on biomarkers for spinal disc pain
0613T - Implantation of shunt in partition between upper heart chambers via catheter, accessed through skin
0620T - Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed
0621T - Laser incision of drainage tissue within eye (trabecular meshwork)
0622T - Laser incision of drainage tissue within eye (trabecular meshwork) using ocular endoscope
0643T - Implantation of restoration device into left lower chamber of heart through catheter
0645T - Implantation of coronary sinus reduction device in heart through catheter
0647T - Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report
0651T - Examination of esophagus and stomach using a magnetically controlled capsule endoscope
0656T - Tethering of 7 or fewer lower spine bones
0657T Tethering of 8 or more lower spine bones
0660T - Implantation of drug-releasing device in front chamber of eye
0661T - Removal and reimplantation of drug-releasing device in front chamber of eye
0662T - Scalp cooling, mechanical; initial measurement and calibration of cap
0663T - Scalp cooling, mechanical; placement of device, monitoring, and removal of device (List separately in addition to code for primary procedure)
0664T - Removal of uterus from cadaver donor
0665T - Removal of uterus from living donor
0666T - Removal of uterus from living donor using a laparoscope
0667T - Transplantation of uterus from donor
0668T - Preparation of donor uterus for transplantation
0669T - Reconstruction of donor uterus, each vein-to-vein connection
0670T - Reconstruction of donor uterus, each artery-to-artery connection
0672T - Radiofrequency remodeling of tissues surrounding female bladder neck and proximal urethra for urinary incontinence
0674T - Insertion of permanent implantable synchronized diaphragmatic stimulation system for augmentation of heart function, including an implantable pulse generator and diaphragmatic leads, using a laparoscope
0675T - Insertion of first lead of permanent implantable synchronized diaphragmatic stimulation system for augmentation of heart function, with connection to existing pulse generator, using a laparoscope
0676T - Insertion of additional lead of permanent implantable synchronized diaphragmatic stimulation system for augmentation of heart function, with connection to existing pulse generator, using a laparoscope
0677T - Repositioning of first lead of permanent implantable synchronized diaphragmatic stimulation system for augmentation of heart function, with connection to existing pulse generator, using a laparoscope
0678T - Repositioning of additional lead of permanent implantable synchronized diaphragmatic stimulation system for augmentation of heart function, with connection to existing pulse generator, using a laparoscope
0679T - Removal of permanent implantable synchronized diaphragmatic stimulation system for augmentation of heart function using a laparoscope
0680T - Insertion or replacement of pulse generator only of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, with connection to existing lead
0681T - Relocatation of pulse generator only of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, with connection to existing dual leads
0682T - Removal of pulse generator only of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function
0683T - In-person programming device evaluation of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function with analysis, review and report by qualified health care professional
0684T - In-person programming device evaluation and programming of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function before procedure
0685T - In-person interrogation device evaluation of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function with analysis, review and report by qualified health care professional
0686T - Acoustic energy destruction of malignant liver tissue using imaging guidance
0687T - Device supply, educational set-up, and initial session for online digital treatment of amblyopia
0688T - Assessment of patient performance and program data for online digital treatment of amblyopia by healthcare professional with report, per calendar month
0689T - Quantitative ultrasound tissue characterization (non-elastographic), including interpretation and report, obtained without diagnostic ultrasound examination of the same anatomy (eg, organ, gland, tissue, target structure)
0690T - Quantitative ultrasound tissue characterization (non-elastographic), including interpretation and report, obtained with diagnostic ultrasound examination of the same anatomy (eg, organ, gland, tissue, target structure) (List separately in addition to code for primary procedure)
0691T - Automated analysis of existing CT study for fractue of spine, with data preparation, interpretation, and report
0692T - Therapeutic ultrafiltration
0693T - Comprehensive full body computer-based markerless 3D motion analysis and report
0694T - Real-time 3-dimensional volumetric imaging and reconstruction of breast or axillary lymph node tissue in surgical specimen, with interpretation and report
0695T - Body surface-activation mapping of cardiac resynchronization therapy device, with review, and report, at time of implant or replacement
0696T - Body surface-activation mapping of cardiac resynchronization therapy device, with review, and report, at time of follow-up device evaluation
0700T - Molecular fluorescent imaging of first suspicious mole
0701T - Molecular fluorescent imaging of additional suspicious mole
0704T - Device supply, initial set-up, and patient education for remote treatment of amblyopia using eye tracking device
0705T - Surveillance center technical support for remote treatment of amblyopia using eye tracking device, at least 18 training hours, each 30 days
0706T - Health care professional interpretation and report of remote treatment of amblyopia using eye tracking device, per 30 days
0708T - Injection of bone-substitute material into defect of bone using imaging guidance and endoscope
0709T - Preparation and initial injection of cancer immunotherapy into skin
0710T - Additional injection of cancer immunotherapy into skin
0711T - Noninvasive analysis of plaque in artery using software processing of CT data, with data preparation and transmission, interpretation and report
0712T - Preparation and transmission of data for noninvasive analysis of plaque in artery using software processing of CT data
0713T - Evaluation of artery wall and plaque to assess stability of plaque noninvasive analysis of plaque in artery using software processing of CT data
0714T - Data review, interpretation and report for noninvasive analysis of plaque in artery using software processing of CT data
0716T - Cardiac acoustic waveform recording with automated analysis and generation of coronary artery disease risk score
0717T - Harvesting of patient's own fatty tissue and preparation of cells for autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear
0718T - Injection of autologous adipose-derived regenerative cell (ADRC) therapy into supraspinatus tendon of one shoulder using ultrasound guidance, for partial thickness rotator cuff tear
0719T - Replacement of posterior joint in single segment of spine in lower back (lumbar) using imaging guidance
0720T - Electrical nerve field stimulation of cranial nerves through skin
0721T - Quantitative computed tomography (CT scan) tissue characterization with interpretation and report
0722T - Quantitative computed tomography (CT scan) tissue characterization with interpretation and report and concurrent CT examination of any structure contained in the concurrently acquired diagnostic imaging dataset
0723T - Quantitative magnetic resonance (MR scan) imaging of gallbladder, bile ducts, pancreas and pancreatic duct cholangiopancreatography (QMRCP), with data preparation and transmission, interpretation and report
0724T - Quantitative magnetic resonance (MR scan) imaging of gallbladder, bile ducts, pancreas and pancreatic duct cholangiopancreatography (QMRCP), with data preparation and transmission, interpretation and report and with diagnostic magnetic resonance imaging (MRI) examination of same anatomy
0725T - Implantation of vestibular nerve stimulation device in one ear
0726T - Removal of vestibular nerve stimulation device from one ear
0727T - Removal and replacement of vestibular nerve stimulation device from one ear
0728T - Diagnostic analysis and initial programming of vestibular nerve stimulation device in one ear
0729T - Diagnostic analysis and subsequent programming of vestibular nerve stimulation device in one ear
0730T - Laser incision of drainage tissue within eye (trabeculotomy) using optical coherence tomography (OCT) guidance
0731T - Augmentative artificial intelligence-based analysis of facial features (facial phenotype) for possible genetic syndromes with report
0732T - Administration of immunotherapy into muscle using electric pulse (electroporation)
0733T - Device supply and technical support for remote real-time, motion capture-based neurorehabilitative therapy, per 30 days
0734T - Treatment management service for remote real-time, motion capture-based neurorehabilitative therapy, per calendar month
0735T - Preparation of tumor cavity and placement of radiation therapy applicator for intraoperative radiation therapy (IORT) at time of primary incision of skull
0736T - Insertion of rectal catheter and flushing of colon with gravity-fed 35 or more liters of water
0737T - Implantation of nonhuman tissue graft into surface of joint
0738T - Treatment planning for magnetic field induction ablation of malignant prostate tissue, using data from previously performed magnetic resonance imaging (MRI) examination
0749T - Bone strength and fracture-risk assessment using digital X-ray radiogrammetrybone mineral density (DXR-BMD) analysis of bone mineral density (BMD) utilizing data from a digital X ray, retrieval and transmission of digital X ray data, assessment of bone strength and fracture-risk and BMD, interpretation and report;
0750T - Bone strength and fracture-risk assessment using digital X-ray radiogrammetrybone mineral density (DXR-BMD) analysis of bone mineral density (BMD) utilizing data from a digital X ray, retrieval and transmission of digital X ray data, assessment of bone strength and fracture-risk and BMD, interpretation and report; with single-view digital X-ray examination of the hand taken for the purpose of DXR-BMD
0766T - Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve
0767T - Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; each additional nerve (List separately in addition to code for primary procedure)
0768T - Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve
0769T Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization (nerve conduction localization), when performed;each additional nerve (List separately in addition to code for primary procedure)
0770T - Virtual reality technology to assist therapy (List separately in addition to code for primary procedure)
0771T - Virtual reality (VR) procedural dissociation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports, requiring the presence of an independent, trained observer to assist in the monitoring of the patient's level of dissociation or consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older
0772T - Virtual reality (VR) procedural dissociation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports, requiring the presence of an independent, trained observer to assist in the monitoring of the patient's level of dissociation or each additional 15 minutes intraservice time (List separately in addition to code for primary service) consciousness and physiological status;
0773T - Virtual reality (VR) procedural dissociation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports; initial 15 minutes of intraservice time, patient age 5 years or older
0774T - Virtual reality (VR) procedural dissociation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports; each additional 15 minutes intraservice time (List separately in addition to code for primary service
0776T - Therapeutic induction of intra-brain hypothermia, including placement of a mechanical temperature-controlled cooling device to the neck over carotids and head, including monitoring (eg, vital signs and sport concussion assessment tool 5 [SCAT5]), 30 minutes of treatment
0778T - Surface mechanomyography (sMMG) with concurrent application of inertial measurement unit (IMU) sensors for measurement of multi-joint range of motion, posture, gait, and muscle function
0779T - Gastrointestinal myoelectrical activity study, stomach through colon, with interpretation and report
0781T - Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and circumferential radiofrequency destruction of the pulmonary nerves, including fluoroscopic guidance when performed; bilateral mainstem bronchi
0782T - Bronchoscopy, rigid or flexible, with insertion of esophageal protection device and circumferential radiofrequency destruction of the pulmonary nerves, including fluoroscopic guidance when performed; unilateral mainstem bronchus
0795T - Transcatheter insertion of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; complete system (ie, right atrial and right ventricular pacemaker components)
0796T - Right atrial pacemaker component (when an existing right ventricular single leadless pacemaker exists to create a dual-chamber leadless pacemaker system)
0797T - Right ventricular pacemaker component (when part of a dual-chamber leadless pacemaker system)
0798T - Transcatheter removal of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography), when performed; complete system (ie, right atrial and right ventricular pacemaker components)
0799T - Right atrial pacemaker component
0800T - Right ventricular pacemaker component (when part of a dual-chamber leadless pacemaker system)
0801T - Transcatheter removal and replacement of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; dual-chamber system (ie, right atrial and right ventricular pacemaker components)
0802T - Right atrial pacemaker component
0803T - Right ventricular pacemaker component (when part of a dual-chamber leadless pacemaker system)
0804T - Programming device evaluation (in person) with iterative adjustment of implantable device to test the function of device and to select optimal permanent programmed values, with analysis, review, and report, by a physician or other qualified health care professional, leadless pacemaker system in dual cardiac chambers
0807T - Pulmonary tissue ventilation analysis using software-based processing of data from separately captured cinefluorograph images; in combination with previously acquired computed tomography (CT) images, including data preparation and transmission, quantification of pulmonary tissue ventilation, data review, interpretation and report
0808T - in combination with computed tomography (CT) images taken for the purpose of pulmonary tissue ventilation analysis, including data preparation and transmission, quantification of pulmonary tissue
0809T - Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, placement of transfixing device(s) and intraarticular implant(s), including allograft or synthetic device(s
0810T - Subretinal injection of a pharmacologic agent, including vitrectomy and 1 or more retinotomies
0815T - Ultrasound-based radiofrequency echographic multi-spectrometry (REMS), bone-density study and fracture-risk assessment, 1 or more sites, hips, pelvis, or spine
0816T - Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (e.g., array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior tibial nerve; subcutaneous
0817T - Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (e.g., array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior tibial nerve; subfascial
0818T - Revision or removal of integrated neurostimulation system for bladder dysfunction, including analysis, programming, and imaging, when performed, posterior tibial nerve; subcutaneous
0819T - Revision or removal of integrated neurostimulation system for bladder dysfunction, including analysis, programming, and imaging, when performed, posterior tibial nerve; subfascial
0823T - Transcatheter insertion of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed
0824T - Transcatheter removal of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography), when performed
0825T - Transcatheter removal and replacement of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed
0826T - Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional, leadless pacemaker system in single-cardiac chamber
0860T - Noncontact near-infrared spectroscopy with provocative maneuvers, image acquisition, interpretation and report for screening for peripheral arterial disease
0861T - Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; both components (battery and transmitter)
0862T - Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; battery component only
0863T - Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming;transmitter component only
0865T - Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion identification, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained without diagnostic MRI examination of the brain during the same session
0866T - Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion detection, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the brain (List separately in addition to code for primary procedure)


Home Monitoring PT INR Guidelines

The beneficiary requires chronic oral anticoagulation with warfarin for a mechanical heart valve, chronic atrial fibrillation, or venous thromboembolism inclusive of deep venous thrombosis and pulmonary embolism on warfarin.

The patient has been anticoagulated for at least three months prior to use of the home INR device and he/she undergone a face-to-face educational program on anticoagulation management and demonstrated the correct use of the device prior to its use in the home.

The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following initiation of home monitoring and home-testing with the device occurs no more frequently than once a week

Managing Anticoagulation

There are at least three strategies for managing warfarin anticoagulation,

  • Physician office-based testing and management
  • Anticoagulation clinics
  • Home PT/INR monitoring with patient reporting or physician-directed self-management.

Most patients being anticoagulated are managed through physician offices, the "usual care" approach.

Individual physicians manage their patients and PT/INR test frequency is generally once every 4-6 weeks. 

The physician's service is billed with procedure code G0250, no more frequently than once every 4 weeks or every 28 days (7 days/week x 4 = 28 days). There must be 28 days between each submission of G0250.

Clinical Example

  • Patient tests 4 times, on Fridays, in April of 2021
  • The patient tested on April 2, 9, 16, and 23
  • Physician bills G0250 on April 23,2021
  • A physician can only bill G0250 once every 4 weeks (28 days)

Covered ICD Codes

  • I26.93       Single subsegmental pulmonary embolism without acute cor pulmonale
  • I26.94       Multiple subsegmental pulmonary emboli without acute cor pulmonale
  • 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
  • I49.02       Ventricular flutter
  • O88.211    Thromboembolism in pregnancy, first trimester
  • O88.212    Thromboembolism in pregnancy, second trimester
  • O88.213    Thromboembolism in pregnancy, third trimester
  • O88.219    Thromboembolism in pregnancy, unspecified trimester
  • O88.22      Thromboembolism in childbirth
  • O88.23      Thromboembolism in the puerperium       
  • T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
  • T82.02XA Displacement of heart valve prosthesis, initial encounter
  • T82.03XA Leakage of heart valve prosthesis, initial encounter
  • T82.09XA Other mechanical complication of heart valve prosthesis, initial encounter
  • T82.110A  Breakdown (mechanical) of cardiac electrode, initial encounter
  • T82.111A  Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
  • T82.118A  Breakdown (mechanical) of other cardiac electronic device, initial encounter
  • T82.119A  Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter
  • T82.120A  Displacement of cardiac electrode, initial encounter
  • T82.121A  Displacement of cardiac pulse generator (battery), initial encounter
  • T82.128A  Displacement of other cardiac electronic device, initial encounter
  • T82.129A  Displacement of unspecified cardiac electronic device, initial encounter
  • T82.190A  Other mechanical complication of cardiac electrode, initial encounter
  • T82.191A  Other mechanical complication of cardiac pulse generator (battery), initial encounter
  • T82.198A  Other mechanical complication of other cardiac electronic device, initial encounter
  • T82.199A  Other mechanical complication of unspecified cardiac device, initial encounter
  • Z95.2         Presence of prosthetic heart valve
  • Z95.3         Presence of xenogenic heart valve
  • Z95.4         Presence of other heart-valve replacement
  • Z95.5         Presence of coronary angioplasty implant and graft
  • Z95.810     Presence of automatic (implantable) cardiac defibrillator
  • Z95.811     Presence of heart assist device
  • Z95.818     Presence of other cardiac implants and grafts
  • Z95.9         Presence of cardiac and vascular implant and graft, unspecified

Tips

  • Self-testing with the device is limited to a frequency of once per week.
  • Testing more frequently than once per week is generally considered not medically necessary.
  • Billing units of service include 4 tests
  • The date of service should be considered as - End date of the final test.

PT/INR - Home Monitoring Codes are, G0248, G0249 & G0250,

  • G0248 - The provider demonstrates the use and care of an INR monitor,
  • G0249 - For home INR monitoring supplies,
  • G0250 - Physician review, interpretation, and patient management of home INR testing for patient 

Note: For the month of May 2021, the physician cannot bill G0250 earlier than 28 days. There must be 28 full days between each submission date.

If G0250 is submitted within 28 days, the claim will be denied.


Check RPM (Remote Patient Monitoring) Guidelines 

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...