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WAIVE Ship Student Health Insurance

 

MP 7.01.125

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Medical Policy    
Section
reporteras de republica deportivaunivision 
Original Policy Date
2:2010
Last Review Status/Date
Reviewed with literature search/11:2011
Issue
11:2011
  round robin eight teams

Disclaimer

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61886 with connection to 2 or more electrode arrays
64553 Percutaneous implantation of neurostimulator electrodes; cranial nerve
64555 peripheral nerve (excludes sacral nerve)
64573 Incision for implantation of neurostimulator electrodes; cranial nerve
64575 peripheral nerve (excludes sacral nerve)

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Codes

Number

Description

CPT   See Policy Guidelines 
ICD-9 Diagnosis    Investigational for all diagnoses
HCPCS  L8680

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Implantable neurostimulator programmer and pulse generator code range
ICD-10-CM (effective 10/1/13)    Investigational for all diagnoses
   G43.00-G43.919 Migraine code range
   G44.00-G44.89 Other headache syndromes code range
ICD-10-PCS (effective 10/1/13)   

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Policy History
Date Action Reason
02/11/2010 Add policy to Surgery section New policy
2/10/11 Replace policy

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11/10/11 Replace policy Policy updated with literature search through August 2011; references 7 and 8 added and references reordered; policy statement unchanged